INTEGRATIVE + ONLINE PSYCHIATRY + HOLISTIC HEALTH

Author: Ron Parks, MD

Promise of Light on other side of a Wood Bridge of wood bridge in deep forest crossing water stream and glowing light at the end of wooden ways; Copyright: khunaspix / 123RF Stock Photo

Expert Mentoring – A Key to Restoring Mental & Emotional Health

Escalating mental health, emotional or related health issues may signal the need for mentoring or guidance.

When help is needed, it can be difficult to find the outside expert support you need. Developing your own personal self as a resource can also be a challenge.

A person in distress often recognizes that their customary coping mechanism and level of support are inadequate. The dependence on learned ways of dealing with adverse life events often does not help for an overload of stressors and emotional turmoil. The experience for some is like being entrapped in a swirl of thoughts, painful emotions and images. Before distress reaches too high a level, is the time to reach out to others for help and guidance.

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Spiritual Emergence, Recovery

Neuroplasticity – Recovery & Transformation

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Recovery and Transformation are often felt to be impossible for individuals with addictions or mental health problem as depression, anxiety, Post-Traumatic Stress Disorder, and other stress or painful conditions.

There is new hope with the advances in neuroplasticity, neuroscience and its technology to identify, modify or change neuro-circuitry, behavior, responses and reactions. Progress in better understandings of the psychology of the human mind and behavior have contributed to greater success in overcoming what was known previously, which in the past was considered hopeless and beyond the reach of those who had been affected by unrelenting, disabling conditions. The study of other healing methods and traditions, as the 12-Step-Programs for addictions, also has led to more successful integrative treatment programs.

As in the first two steps of 12-Step-Programs, for addiction recovery, there must first be the acceptance of the disease as such, and realization of the impossibility of recovery without profound change. Pursuing treatment on a superficial level for an addiction or any other persistent or chronic illness often fails, such as making limited attempts to make cosmetic changes in one personal way, learned habits, or in the expectation that medication will help. To the person afflicted, life has become unmanageable, and the individual “me” admits to being powerless to make the deep changes needed for recovery. The nature of the illness often has led to feeling hopeless, helpless and powerlessness.

The reason for repeated failures or relapses is that a person unsuccessfully tries to use what was learned from earlier life as:

  • non-effective coping
  • use of manipulation and attempts to control others and the environment
  • efforts to rebuild failing relationships to fulfill unmet needs for nurturance, love, and acceptance
  • repeated ineffective efforts to feel sufficient, empowered and adequate

To recover and transform, one has to get beyond ego, personality, habits, reactions, and behaviors.

If there comes a realization of the powerlessness to change the existing status quo, the opportunity exists to embrace the insight that there are the greater potentiality and possibilities beyond a person’s individual ways and self-identity. When one can’t find any viable alternatives from the repertoire of prior failed actions and behaviors – one has “hit the wall” or “rock bottom” – survival is threatened, the need to tap into a greater “well of resourcefulness” hopefully becomes apparent. After running out of the “customary” choices for survival, there has to be a willingness to let go of the old and embrace options out of the larger sphere of positive possibilities – turning one’s life over to a “higher power.”

The idea for acceptance of a higher power is confusing to some that come to 12-Step-Programs, who may associate this with earlier life negative religious experiences or associations with an abusive authoritarian or dominating figure, especially if there has been traumatic abuse. Gaining flexibility to explore and invest in behaviors or practices to bring about recovery and transformation is what is needed. When stuck in an inflexible state of a rigid self, one needs to shift from an unproductive personal belief about power and control existing in the limitation of individual development and programming since birth, to the realization that there is much more: a greater potentiality, a higher resource beyond the personal limitations and rigid entrapments.

One of the barriers to change relates to deep held core beliefs of:

  1. not being safe
  2. not being loved
  3. not being enough
  4. not being worthy – burdened with guilt and shame

Arriving at a place of great despair, a “dark night of the soul,” there is a need of letting go of the established, old limiting “ego identity.” Embracing spiritual attunement becomes the only viable option, with an acceptance that there is a greater field of possibilities and potentialities, where love, acceptance, and inclusion prevail. Embracing the essence of being – the higher power – allows for profound empowerment and motivation for the steps required for transformation – restoration of “sanity” as identified in the 2nd of the 12 Steps.

Spiritual emergence

is the experience of personal awakening, beyond the constriction and restriction, set by the trained and programmed part of the mind (the ego) – to a higher level of perception, realization, and functioning. A new developing integrative addiction treatment program in Asheville, NC – Center for Spiritual Emergence (see their website) – describes spiritual emergence as a “natural opening and awakening that many people experience as a result of coming to terms with the difficulties of life, through an established faith tradition, as a result of systematic spiritual practices or through unexpected peak experiences.  Spiritual emergences gently allow one to experience and embrace their natural connection to the transcendent domain, forever changing their limiting self-concepts into a more integrative, awakened self”.

Psychoneuroplasticity (PNP)

as presented by Lawlis in his well-done book – Psychoneuroplasticity Protocols for Addictions (Lawlis et al. 2015) is portrayed as an evidence-based science with restorative, rehabilitation, and transformational tools and applications. PNP is founded on post 0716 edit mindset-developments in neuroscience, neural therapies, rehabilitation medicine, addiction and other integrative approaches to mental health treatments.  Though the book focuses on evidence-based treatment approaches for addiction, it is very applicable to the care of other mental health issues and problems and supports the value of integrative approaches and therapies. Brain plasticity is based on the understanding of brain activity, neuronal circuitry, and the ability for the stimulation, modification, retraining, and growth of nerve cells and their complex networks.

Positive brain plasticity can be helpful in many problematic areas as:

  • cognitive processing, worries, physical pain, migraines
  • emotions, depression, anger, reactiveness, stress
  • anxiety, fear, phobias, obsessiveness, distractibility
  • alertness, focus, arousal, ADHD, brain fog, fatigue
  • PTSD, sleep disturbance, addictions, cravings, over-weight

To set the stage for healing, recovery, transformation, and neuroplasticity, any difficulties in above noted areas, may need to be addressed early on. Several are discussed in greater detail below.

Anxiety and fear

can be a disabling condition and a major interference with life and productivity and can act as a barrier to recovery from other mental health condition, including addictions and other health problems. The following can contribute to anxiety or panic like conditions:

  1. unmanaged stress
  2. prior life losses and trauma
  3. lack of adequate parenting or an early life nurturing environment
  4. adverse effects from medication and drugs
  5. life-threatening physical illness

Resulting impairment can become chronic with only temporary relief, if any, from drugs or use of substances that could be harmful to one’s health and well-being. Studies of brain waves often will show high-frequency beta waves in localized regions of the brain suggesting increased activation and the need to retrain and repair the brain’s neural networks to more relaxed frequencies and a healthier state. Mental health professionals sometimes will label people as having other mental health conditions or personality disorders, like borderline personality disorders, because they have not been able to grow and mature emotionally. The behaviors and personality may be related to earlier life abuse, persistent severe anxiety, and feelings of being overwhelmed – resulting in resistance or the inability to resolve severe chronic anxiety that blocks healthy development around their families, social network, and peers.

Traumatic life events

can lead to post-traumatic stress disorder (PTSD), which can either be of a simple type where there has only been one major traumatic event or complex where there have been multiple accumulative traumas. A person’s life development can get stuck in a time-relation to an earlier trauma. Integrative type treatment protocols and therapies focusing on treatment of  trauma, as those presented by Lawlis (Lawlis et al. 2015) have the potential to bring relief by relieving the emotional connection to trauma memories and supporting positive brain changes and plasticity . The use of neurofeedback type treatments as the BAUD (bioacoustical utilization device) can disrupt the reconsolidation of traumatic memory and has been shown to relieve symptoms of PTSD (RESET Therapy). Relaxation or stress-reducing therapies, music, meditation practices, breathing techniques, nutritional diet, neuro-biofeedback and skill development can be a part of neuroplasticity enhancing protocols. Other sensory or trauma-focused therapies as EMDR, are also utilized to form new and healthy neuro-circuitry and response patterns.

Depression

can interfere with recovery and be due a multitude of factors including:

  • response to negative life events, chronic stress, trauma, and losses
  • low self-esteem
  • genetics, nutritional deficiencies, and medical illness
  • toxic environmental exposure including to drugs and alcohol

With depression there may be associated: ruminations and obsessional thought, as seen in OCD (Obsessive Compulsive Disorder); anxiety; loss of productivity; feelings of loss of control; loss of interest in things; a downward spiral of increasing depression and development of suicidal thinking, which can lead to loss of life or complication with other medical illness. If suicidal thinking occurs, immediate help should be sought from mental health professionals.

The brain, if studied with EEG brain wave studies in identified areas of the brain, will show a pattern of under activation and low voltage waves. Neuroplasticity focused protocols look for healthy interventions to bring these areas of the nervous system back online and restore responsive feelings, energy, joy and happiness without the individual resorting to using potentially dangerous drugs or chemicals. Intervention may include therapies as noted above including:

  • neurofeedback or neuro-therapies, BAUD
  • psychotherapies including trauma-focused therapies as EMDR
  • exercise, nutritional diet, supplements
  • sound, rhythm, aroma, movement, and dance therapy
  • mindful meditation, breathing techniques
  • social network development with active peer support
  • coping, relapse prevention, and social skill development

Cyclic patterns of disturbed emotions and behavior

can interfere with recovery. These can present as periods of irritability, rage, heightened anxiety, obsessiveness, sleep disturbance, periods of dramatic increase in activity and hyper focus alternating with times of fatigue, depression, loss of motivation and loss of interest in things. These patterns are sometimes labeled as being in the Bipolar Spectrum (see Dr. Parks article) but can also be related to PTSD and prior accumulative trauma. Many of the above-noted treatments and others are considerations to correct altered behavioral pattern, skill deficits, dysfunctional brain patterns, and neuro-circuitry.

Consider broader integrative or neuroplasticity related approaches if you or a loved one has difficulties with any the above-discussed symptoms or conditions. Seek out competent and well-trained health care practitioners trained in these areas.

Written by Ron Parks, MD, edited by Shan Parks

Question:

What symptoms or conditions do you or a significant other have that may be helped by one of the above-discussed approaches? I would be interested in your comments or opinions. Please respond below.

Awareness is often ignored, which is one of the most significant of factors for healing - opening the door to healing

Awareness – The Core of Healing

awareness opening door

“Why do you stay in prison when the door is wide open?”

From Rumi the 13th Century Sufi mystic poet

Awareness is often ignored, which is one of the most significant of factors for healing.

Developing awareness, especially to constricting attachments, is an important step in the recovery from illness and pain.  Centuries ago, the Buddha realized the link between suffering and attachment. In sickness, the mind tends to hold tightly to a narrowed set of thoughts, interpretations, and feelings. The repetitive focus leads to entrapment in the mental activity defining the health threatening conditions. The mind is naturally drawn to what is considered a threat as it then gives immediate attention to what the body needs. For healing to occur, however, there needs to be a shift towards a greater awareness and openness for new opportunities, solutions, positive health behaviors, adaptations, and skill development.

Someone who has chronic pain, addictions, depression, cancer or any life-threatening illness – experiences different levels of suffering during the disease. As a result from the illness, the person may find their mind is locked into thoughts about their losses. Fears may begin to develop regarding future difficulties. An individual may worry about death, the loss of function, or the capacity to work or care for one’s self or others. An important aspect of the healers work is to provide a listening presence, wise guidance and education. Also needed, is the sharing of techniques that facilitate the release from unhealthy attachment – especially to rigid ideas, concepts, and unproductive worries. The hope is to help alleviated pain and suffering, and to enhance healing and well-being.

The healing arts have adopted fundamental ideas, which were derived from schools of spiritual philosophy, psychology, and religion.

The value of bringing awareness to the mind’s activity are emphasized for both healer and sufferer, which then counter tendencies towards fixed or rigid ideas as well as judgments and reactions. The so-called self-ego is our developed mental sphere of self-centered awareness, which contains our patterns of reactivity and response. Tight identity with the self-ego has a relative functional role for us as it aids us in adapting, interrelating and functioning in the everyday world. This developed self-ego has locked in perceptions and ideas of what different experiences mean in regards to rewards, nourishment or threat. Depending on the type of learning, parenting and earlier life experiences, the self-ego gets imprinted with adaptive or maladaptive learned patterns, reactive thoughts (judgments), concepts, images, and responses. In the case of early life trauma, for example, patterns and reactive thoughts may be maladaptive with less flexibility to adapt to changing circumstance, which gets perpetuated as pain and suffering.    see article on: Trauma – PTSD

dark cloud to awarenessWith illness or severe loss, the developed self-concept of one’s world is held more tightly.

The person then begins to be less adaptable to change and feels more vulnerable, which intensifies his or her fear and suffering. The degree of pain depends on the level of attachment to one’s developed worldview or biased perceptions, so the tighter the attachment, the greater the person’s inflexibility –  resulting in suffering. With greater rigidity comes a lessened ability to adapt, to change, to heal or transform. It is considered a healing crisis when an opportunity exists that moves along the natural developmental lines towards openness, acceptance, flexibility and spiritual growth. If you examine the healing process and spiritual growth, the essential ingredient in both is the ability to experience or recognize a “felt sense,” which is larger than one’s embedded cluster of ideas, reactivities, and repetitive pattern of responses to experienced situations. The degree of pain depends on the level of attachment to one’s developed worldview or biased perceptions, so the tighter the attachment, the greater the person’s inflexibility – resulting in suffering. With greater rigidity comes more significant pain and a lessened ability to adapt, to change, to heal or transform. It is considered a healing crisis when an opportunity exists which moves along natural developmental lines towards openness, acceptance, flexibility and spiritual growth. If you examine the healing process and spiritual growth, the essential ingredient in both is the ability to experience or recognize a “felt sense,” which is larger than one’s embedded cluster of ideas, reactivities, and repetitive pattern of responses to experienced situations.

Attempts to define or describe the undefinable, this “felt sense” of the greater, larger, all-inclusive space of being, which can be considered the infinite space of potentiality — has led to confusion due too many concepts or terms generated from the many fields of human endeavor: as science, spirituality, religion, and mysticism.  see article on: Depression

One’s ability to gain freedom from mental or physical suffering and attachments is aided by:

  1.  realization of the healing space, which may be beyond one’s contrived limiting self-notions of what we believe
  2.  getting beyond personal rigid fixed ideas, concepts, and beliefs
  3. allowing for movement and release from repetitive thought, actions, and behaviors
  4. developing an openness to a sense of more possibilities, flexibility, fearlessness, peacefulness, and serenity

Awareness, openness, acceptance, and flexibility contributes to better life adaptation, recovery, and healing.

Being stuck in fixed behaviors or patterns may be part of the actual cause or the perpetuation of illness.

The ability to be flexible and to make a change contributes to healing. If caught in an inflexible self-ego, a clouded level of awareness, or a lack of spiritual insight, one truly is in the dance of suffering and decay; while one awaits a release to freedom, new expression, and new experiences.

Alba con cielo blu e nuvole

Most schools of spiritual development teach the importance of following some form of regular practice. Gradual movement is encouraged – from rational thoughts, feelings, emotions and body awareness, to the freeing experience of the profound silence and serenity – as in prayer, meditation or contemplation. The release into the peace of “open awareness” goes beyond the usual mental activity of interpretation and judgment.

Each tradition has teachings related to:

  • the care and nurture of the body, mind, and spirit
  • the achievement of greater happiness
  • the gaining of freedom from the bondage of entrapment in a shallow, unenlightened world of an inflexible self-ego.

With development and practice, the division of self-ego and the spiritual awareness melt away into an experience of oneness and unity.

The progression to enlightenment often follows a course of gradual awakening of awareness, along with total acceptance of change and impermanence, which allow one to experience the deep witnessing that is always eternally present. The experience of an enlightened consciousness can either happen as a sudden shift, or as a mere glimpse in the course of practices, or may occur after some catastrophic event or bout of severe suffering. Integrative psychiatry and nondual therapies support and nurture the development of a stronger, yet flexible sense of self, self-awareness and self-esteem as part of the healing process. The goal is to promote a better functioning and adaptability to everyday life stresses. At the same time, work is done to enhance the individual growth and development beyond the personal self –  as well as the entrapping experiences of everything being about me or mine, to the deeper and more expansive realm of spiritual realization.  This exists as the natural state of peace, happiness, well-being and release from suffering. See article on: The Secret

Some practices to consider, for integrative healing and joyful progress, which are along the different lines of personal, compassionate, and balanced development of a healthy body, mind, soul and spirit:

  • nondual oriented therapies
  • active, consistent exercise, along with a balanced program of rest and recreation
  • yoga, chi gong, and meditation
  • spiritual practices from either one’s background, or from other religious or spiritual traditions
  • addiction and substance abuse treatment – if needed
  • reducing exposure to harmful environmental toxins and allergens
  • correction of medical, metabolic or hormone issues
  • following a more nutritious, organic, plant-based diet with correction of deficiencies — vitamins, minerals, and essential fatty acids; and health enhancement with herbs and botanicals
  • massage, acupuncture, deep relaxation, and other body-based therapies
  • “other-serving,” volunteer and community service work; charitable and compassionate assistance to others in need; caring for a pet
  • communing with nature and caring for the environment (personal and outside).

Study with a credible, well-trained and trustworthy nondual therapists, a spiritual teacher or a mentor when the opportunity presents itself. Read and study – individually or in groups – the writings and teachings of the great spiritual teachers, as well as other philosophies, and traditions. Be compassionately present. Be who you are, fully aware, liberated and open to the all existing potentialities — not a “who” that is constricted by limiting mind programming, learning, or limiting sets of reactivity patterns as from trauma experiences.

written by Ron Parks, MD, edited by Shan Parks

Resources and References:

Website/Book – In Touch

Book – The Sacred Mirror

Book –  Listening from the Heart of Silence

Article –  The Fourth Wave of Behaviorism: ACT, DBT, and Nondual Wisdom

Website: Radiant Mind

Question:

Have you had a deep awareness or awakening experience that has brought a positive change in your personal healing or recovery? Please share if you wish or comment.

Man with PTSD, terror, trauma

PTSD, Terror and Trauma – Holistic Approach

PTSD, terror, trauma  – how common and what to do after recognition?

A greater number of people, appear to be now having more exposure to terror events, trauma and are developing an increase in trauma-related illnesses, including PTSD. The causes could be attributable to any of a long list of suspected or debatable factors. It is valuable to focus on what we do know about trauma and the development of trauma-related illnesses, so as to work effectively on prevention, early recognition, treatment, and recovery.
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Are there more sensible and holistic approaches to trauma related problems?

About seventy percent of adults in the U.S. have experienced a traumatic event at least once in their lifetime. Ten percent or more of these people will develop PTSD according to some studies. Women are about twice as likely as men to develop PTSD (one out of nine women); see more at ptsdunited.org..  About 8 out of every 100 people (or 8% of the population) will have PTSD at some point in their lives. About 8 million adults have PTSD during any given year, which represents only a small portion of those who have experienced trauma; see more at ptsd.va.gov.

When you look at current statistics on PTSD (Post Traumatic Stress Disorder) and TRI (Trauma Related Disorders) – also referred to as Trauma Spectrum Disorders – two immediate questions come to mind. Is it a growing epidemic, or is it an expected outcome from the level of dysfunction and violence in our society — in our homes, on the street, in the workplace or on the battlefield? If the answer to both questions is yes, and if we are seeing more victims and sufferers from the effects of trauma, what then can we do as individuals and as a community? Can there be hope for a more sensible, comprehensive approach to include prevention; earlier recognition of the acute and lingering effects of trauma; timely interventions; proper diagnosis; application of more holistic, integrative and innovative treatments; and improvement in availability of services and resources.

Most people would not expect trauma-related illnesses and PTSD to show up from events which can occur outside of the military. Most people who are affected often go unrecognized and never seek treatment. They continue to suffer the ill effects of trauma and its aftermath.

Now it is recognized that the effects of trauma and it aftermath can occur to anyone at any life stage – childhood or adulthood.  The trauma itself can result from a wide variety of experiences:

  1. Exposure to threatened death, serious injury, auto accidents or violence
  2. Feeling helpless during a trauma as childhood sexual abuse, rape, physical assaults
  3. Major overwhelming adverse life threatening events (early life or in adulthood) or poly-trauma (i.e., series of traumatic events: as a job loss, divorce, death of a significant other)
  4. Sudden or major emotional losses
  5. Witnessing domestic violence, death or injury to others
  6. Natural disasters or mass causality event as a terrorist attack

The list of the many different types of trauma is extensive and affects each person differently.

There are a number of contributing factors that can make an individual more vulnerable to PTSD or TRI including earlier life traumas as listed above and some of the following additional vulnerability factors:

  1. Having less social support
  2. History of another physical or mental health problem such as a co-morbid substance use disorder
  3. Recent losses
  4. Contributing genetic factors

Martha is a survivor of terror and trauma.

Martha* was a well-liked and very effective 8th-grade teacher in her inner city school. Her students admired her for her understanding, effective teaching and leadership in several extracurricular programs – as the school drama club. She came to work one day, visibly shaken, reporting that two older teens had pushed her down and stole her purse when she was leaving her house – in what she thought was a safe neighborhood. She was upset and anxious for most of the day and the next, but she seemed to get back to her usual self and pace by the third day. Two weeks after this occurrence, arriving at school a half hour early to catch up on some paperwork, she was suddenly shoved through the entrance door by a large man from behind, causing her to fall to the ground. She started to scream but stopped when hit by the attacker with a glancing blow on her arm with a gun. Some other staff and students began to arrive, causing the nervous assailant to turn and flee. Martha went to her physician, and he found no physical injuries or any evidence of head injury. He offered some tranquilizers, which she refused. After a few days, she felt well enough to return to work. Over the next few weeks, going into a month, she felt easily distracted, began to startle easily, especially to sudden movement or noise. Her sleep was often disrupted with nightmares of being attacked or chased. For the first time, she began having what she and others described as panic attacks – with the sudden onset of a pounding rapid heart, an overwhelming feeling of dread that something terrible was going to happen and an urge to flee or leave the room. She could no longer drive herself as panic attacks would occur while driving. She had to take sick leave from her teaching work, and she sought out professional help.

The first doctor felt she had ADHD or attention problems and prescribed a commonly use stimulant type drug to help her focus.  This only made her worse: more anxious with difficulty sleeping, jumpy and irritable. She went to someone else who felt that her main problem was depression and anxiety — he tried her on an antidepressant that again seemed to make her worse. When he wanted to change her to a bipolar condition medication, she decided to go to another health care provider. The therapist, who saw her, recognized the impact that the trauma experience was having on her. The therapist recommended someone specialized and experienced with specific trauma-related therapy and treatment. She also saw a holistic physician that helped her improve her lifestyle, nutrition and exercise program. Martha reported that she had been sexually and verbally abused as a child growing up with an alcoholic mother and often absent father. She was often bullied by her peers as she was somewhat shy as a child. Her recovery was gradual, but Martha was able to resume her effective classroom work with her students after three to four months.  *(To protect confidentiality, the above is a composite of some clinical experiences and does not represent an actual person or any prior patients).*

The annual cost to our medical care system for PTSD and TRI is staggering – in the billions of dollars, which is often compounded by misdiagnosis and improper treatment. Beyond the actual treatment costs, there are the related workplace costs; drug costs; and cost of other associated illness, disabilities and mortality.

It is estimated that 80%-90% of persons exposed to the various types of severe trauma will not develop PTSD. Predisposing — vulnerability factors — are the more important deciding factors as to whether an individual gets a trauma related illness or not, more so than the trauma itself. The traumatic experience can have profound effects on some and very little effects on others who experience the same event.  What makes one more susceptible to post-trauma problems and another not – is of great interest now. Where there is more exposure, there is more potential for traumatic experiences and the occurrence of trauma related illness – as was the situation with Martha, as described above.

For a detailed description of trauma related illness and PTSD symptoms see the official DSM-5  (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 by American Psychiatric Association (APA), available through the APA or at Amazon .

Recognizable intermittent or chronic emotional or physical symptoms that may be a sign of TRI or PTSD from prior trauma or trauma exposure may include:

  1. Re-living: People with PTSD repeatedly relive the ordeal through thoughts and intrusive memories of the trauma — including flashbacks, hallucinations, nightmares, feeling great distress when reminded of the trauma, acting and feeling as if the trauma were recurring and psychological distress
  2. Avoiding or feeling numb: the person may avoid people, places, thoughts or situations that remind him or her of the trauma, inability to recall an important aspect of the trauma; feeling of detachment or estrangement from others; isolation and withdrawal from family and friends – as well as a loss of interest in activities that the person once enjoyed; difficulty experiencing love, joy or intimacy – a restricted range of feelings; difficulty relating to others; diminished interest or participation in significant activities;  sense of foreshortened future
  3. Increased arousal as: having excessive emotions, worry and guilt; difficulty falling or staying asleep; feeling nervous, fearful; increased irritability; outbursts of anger and agitation; difficulty concentrating; being hyper vigilant, guarded and constantly alert;  physiologic reactivity upon exposure to trauma cues and having exaggerated startled responses – being jumpy
  4. Experiencing worsening physical symptoms and medical problems, e.g., increased blood pressure and heart rate, fatigue, rapid breathing, muscle tension, headaches, sweating, digestive problems, poor appetite, nausea, and diarrhea

The onset of trauma-related symptoms or illness can be delayed, emerging months after the traumatizing event. However symptoms may appear, earlier, be more subtle and difficult to recognize. Other symptoms or characteristics of TRI and PTSD that may occur include:

  •  Feelings of hopelessness, helplessness, shame, despair or sadness
  • Distrust of others
  • Self-blame, negative views of oneself or the world
  • Family, employment or school problems
  • Relationship problems including conflicts, being over-controlling, violence and divorce
  • Failure to engage in exercise, diet, safe sex or regular health care
  • Excess smoking, alcohol and drugs problems
    Violence of man against womanSee National Center PTSD Fact Sheet

More info at Medscape – does require a free registration)

An integrated holistic approach would be to bring together the tools, practices and scope of integrative psychiatry, psychology and medicine. The goal would be for early recognition, assessment, diagnosis and treatment of people with symptoms or problems resulting from trauma — including an investigation into contributing factors as those related to prior traumatic exposures; environmental, genetics, medical and psychological issues; and developmental and family history. The tools of integrated psychiatry and psychology would include in-depth clinical history and psycho-social assessment, physical examination, psychological testing, consulting with significant others – like family members, laboratory testing – and finally a comprehensive treatment program.

Treatment considerations would be:

  1. Lifestyle and nutritional improvements
  2. Reduction in psycho-social stressors
  3. Individual or group psychotherapies that address current, past developmental and trauma issues
  4. Interventions as suggested by clinical finding and lab testing

Medication use is a consideration after other contributing factors have been addressed, and non-medication interventions have not been adequate. Medications commonly considered are:

  • Selective serotonin re-uptake inhibitors for depression and anxiety (SSRIs; e.g., fluoxetine, sertraline)
  • Symptomatic treatments with sleep agents or more helpful for trauma-related nightmares in adults — prazosin — an anti-hypertensive
  • Benzodiazepines (tranquilizers)— long-term use does not appear beneficial and difficult to wean and stop
  • β-blockers — used to reduce arousal but of questionable benefit.

If there has been significant trauma and apparent TRI or PTSD — a team or network approach would be optimal — this would include health care practitioners trained in the modalities referred to above, plus the presence and needed interventions by an experienced trauma therapist. Therapy may involve different approaches depending on the training of the available trauma therapist as:

  1. Individual or group psychotherapy
  2. Behavioral or cognitive behavioral therapy (CBT)
  3. Exposure therapy, trauma-focused cognitive behavioral therapy, trauma systems therapy
  4. Body-mind therapies, somatic experiencing, eye movement desensitization and reprocessing (EMDR), Emotional Freedom Technique, Reset Therapy –  see E-book on RESET by Lindenfeld.
  5. Other natural alternatives or medication

See PTSD.VA.gov treatment of returning vets

The role of the holistic and integrative health care practitioner would be to add his unique skills and knowledge to the team or network of practitioners, experienced with the treatment and management of someone experiencing TRI or PTSD. As there is often dysfunction or problems in multiple areas, a careful and thorough diagnostic evaluation is needed. Any corrective interventions will help to alleviate symptoms or  illnesses – as treating any infections; digestive disturbance; nutritional or hormonal imbalances; allergies; drug, alcohol addiction problems; emotional and mood problems; personal or family stressors – with the goal of improving comfort, well-being, sleep and restoration; and improvement of autonomic Well-being, Peacefulnessregulation. All of these interventions would be potentially helpful in assisting recovery, along with the assistance of a trauma therapist when needed. Procedures or lab testing that is indicated would be done: as nutrition and digestive evaluation, thyroid and hormonal testing, blood chemistry as complete blood count, blood sugar, lipids, B12 and folic acid levels, vitamin D 25-hydroxy levels, and more specific and advanced testing if indicated.  If with treatment, the person can become less stressed from contributing psycho-social and medical factors, have more restorative sleep, be more free of pain and discomfort, get relief from environmental related illness and allergies, and relief from traumatic memories — there would be more possibilities for the body, mind and spirit to recover from the wounds of trauma.

Other treatments, mind-body therapies or psychotherapies, tests currently available or in development are beyond the limited scope of this article. If interested, see above linked references and my prior article and references – PTESD.

Be knowledgeable and prepared for when anybody that you know or meet with TRI or PTSD needs your support, help or encouragement. Healing or reducing somatic, emotional, mental and spiritual issues, and other factors contributing to the severity of TRI and PTSD – in conjunction with medication when needed — has the potential for relief and the reduction of  suffering from illness associated with recent or prior trauma.

Article by Ron Parks, MD and edited by Shan Parks – see related slide presentation in Library http://ronparksmd.com/jfk-lecture-092016/

[reminder]How could you be helpful to yourself or a significant other when suggestive or actual symptoms of TRI or PTSD appear? I’d be interested in your comments.[/reminder]

Pampas Grass in natural setting

Bipolar Holistic Treatment – Part 2

A Holistic integrative approach to the study and treatment of Bipolar Illness — BPI (also referred to as Bipolar or Manic-Depressive Disorder) offers a better path to disease understanding, treatment and prevention. See prior post “Holistic Approach to Bipolar Illness”.

Ben is not doing well with his bipolar illness.

Ben* is on several medications prescribed by his psychiatrist and has just come back from a recent psychiatric hospitalization for his bipolar disorder. He had been hospitalized after he had an emergency room visit for a suicide attempt, after he had taken an overdose of his medications. Prior to that, he had progressively worsening depression with feelings of hopelessness, helplessness and had lost interest in almost everything. He felt that there was no help for him as his mood cycling illness was only getting worse – even with all the medications he was taking. The medications made him feel like a “Zombie.” He was sleeping less with frequent violent nightmares that had woken him up multiple times during the night. He had periods of severe depressed mood when he would stay in bed for most of the day. He would have then have some days of feeling relatively fine.  He then would experience periods of feeling – super “hyped-up” –  full of energy with little need for sleep, talkative with racing thoughts, craving sex and food all the time, feeling like he was a famous rock star, and spending huge amounts of money on things he really didn’t need. He had lost all of his recent jobs and was now divorced from his second wife.

In addition to his regular psychiatrist, his family encouraged him to see and work with a holistic, integrative health care practitioner and therapist. It was uncovered that he also had a significant alcohol problem (as did his bipolar and alcoholic mother), a history of severe early life trauma – probably PTSD, severe gluten sensitivity, and autoimmune thyroid disease with thyroid imbalance. When he was directed to specific treatment and therapy programs for his bipolar illness, his PTSD, alcoholism, nutritional problems and thyroid disease; he was then able to work closer with his regular psychiatrist.  His medications were reduced, and for the first time he began to sleep better with less mood cycling. His new therapy work also helped him to identify and work through some painful childhood issues. He also felt that he regained his spiritual connection.

*(To protect confidentiality, the above is a composite of some clinical experiences and does not represent an actual person or any prior patients).

Finding a better model for helping BPI.

A broader open health-care model offers the potential for improved research, diagnosis and treatment of BPI. All disciplines can be included in an integrative model – including biochemistry, nutrition, psycho-pharmacology, psychiatry,  genetics, spirituality, psychology, sociology, physiology, endocrinology, environmental medicine and complementary mind/body/spiritual therapies. Effective outcomes can happen with patience, and the commitment to finding a suitable care and treatment program.

Early recognition, comprehensive assessment and an integrative approach to treatment – including natural therapies – can help bipolar sufferers improve their chances of stabilization, improvement in relationships, and productivity and work. As proper assessment and diagnosis can be of critical importance, seeking out skilled and experienced health-care practitioners is important – such as a psychologist, a psychiatrist, and/or a holistically oriented health-care provider who is trained in mental health work.  People with bipolar illness are sometimes misdiagnosed as having just depression or other conditions – and treated as such – often resulting in a poor treatment outcome.  These individuals would have responded better to a broader holistic and integrative type of treatment program that had benefited Ben’s recovery as described above.

Every individual is unique in their treatment needs.

Woman with Bipolar Disorder
©Sangolrl/Dollar Photo Club—Balancing Act.

Any individual who has difficulties with mood changes is unique regarding their treatment needs.  BPI can be influenced by factors as:

  • a person background
  • earlier life experiences, exposures or trauma
  • current lifestyle, nutrition, environment
  • individual medical issues, genetics
  • personality
  • psychological or addiction issues
  • traumatic brain injury

A person’s capacity to grow in awareness, learning, and to succeed with lifestyle changes will influence the choices and success of any selected treatment. As there are many individual differences as well as variation in the type and severity of bipolar conditions, the needs and type of treatment will vary or differ from person to person.

Natural non-medication approaches

Some of the non-medication or more natural approaches would be:

  1. improving lifestyle, nutrition, exercise and sleep
  2. addressing environmental issues
  3. stress management
  4. individual or group psychotherapy
  5. avoidance of alcohol and substance abuse
  6. education, behavioral, family, cognitive or trauma therapy
  7. other complementary mind-body-spiritual oriented programs.

Other complementary practices or therapies would be:

  • relaxation training, yoga
  • Oriental Medicine, acupuncture
  • religious, meditation and spiritual practices
  • regular exercise and sleep
  • use of fish oil, rich in EPA and DHA – has been shown to complement other treatments of BPI.

There is a body of work suggesting that nutrition and certain dietary programs can help in treatment of mood disorder, as a diet:

  1. high in healthy fats
  2. high in vegetables, rich in minerals and anti-oxidants
  3. adequate in good quality protein
  4. low in sugar and starches
  5. that avoids gluten (found in wheat, rye and barely — felt to be a trigger in some people for inflammation and auto-immune diseases). (see Grain Brain)

Specially designed light boxes, if carefully used under the guidance of an experienced health-care provider, are sometimes useful (especially if there is a seasonal component to the depression and mood cycling). Assessment and correction for any nutritional, metabolic, hormonal (as thyroid deficiencies), allergic or environmental problems need to be considered.

A genetic biochemical problem that can be improved with nutrition, called hypomethylation is worth assessing – as there is evidence that it affects the expression of bipolar symptoms – and if treated can bring benefits and improve outcomes. Methylation is also relevant to drug-nutrient interaction in the treatment of BPI and is one of possible underlying factors that can contribute to medications not working effectively. (see  “Bipolar Disorder” by Vinitsky and Parks, Advancing Medicine with Food and Nutrients, 2nd edition, Chapter 32, Dec. 2012, CRC Press)

Medication considerations

Some of the conditions or consideration for medication interventions and treatment are:

  • worsening of BPI with poor response to non-medication approaches
  • development of thought or cognitive impairment such as psychotic symptoms with delusion, hallucination or dangerous behavior, especially when accompanied by poor judgment and risk of self or other harm
  • actual or imminent need for a safe protective environment — psychiatric hospitalization
  • lack of capacity or willingness to follow non-medication treatment regimens or protocols
  • personal choosing of medication treatment over non-medications (after being fully educated about all options, including therapy programs or natural alternatives – other than medications) about risk of using medication vs. not taking them, potential for adverse immediate or long-term risks, or side effects from medication

According to some studies, those with bipolar disorder – not treated with appropriate medication or a mood-stabilizing agent when needed – have a significant increase risk of a more chronic condition, more frequent relapses of the illness and more severe outcomes – as suicide*.  More than 50 percent of people will abuse drugs or alcohol if the disorder is not recognized or treated.

Concerns about medication and risk:

  1. potential for short term, long term, or potential side effects: including weight gain, diabetes, metabolic problems, high blood pressure, heart disease, abnormal restlessness and/or involuntary movement disorders of face, mouth and limb (mostly a risk with anti-psychotic medication and possibly from some of the antidepressants)
  2. potential for making mood cycling worse or triggering more severe episodes of mania or psychosis.

So it is important for the individual to be educated about the use medication, benefits and risk – weighing the potential benefits of medication being helpful – especially in a well designed comprehensive treatment program – vs. risks of medication use and side effects.

There are several classes of medications considered when felt necessary in BPI, including:

  1. Anti-depressants: as citalopram and sertraline, which are selective serotonin re-uptake inhibitors – SSRIs that increase the amount chemical nerve factors (neurotransmitters) that helps relieve depression
  2. Anxiolytics (anxiety reducing medication) such as: benzodiazepines such as clonazepam and lorazepam that support the neurotransmitter GABA which helps relieve anxiety
  3. Mood Stabilizers as lithium, valproate and lamotrigine that helps to balance and stabilize brain activity and neurotransmitters (active brain chemicals) which sometimes have an antidepressant effect – as lamotrigine
  4. Antipsychotic Medication as: aripiprazole, risperidone, and lurasidone: helps to eliminate or reduce psychotic thoughts, which is abnormal or disturbed thinking as delusions and hallucination, helpful in reducing agitation, helpful with mood stabilization and sometimes helpful in reducing depression; read more: nimh.nih.gov/health
Fantastic sunset
©Allk Mullkov/Dollar Photo Club—Beauty in Nature.

Appreciating the many facets of BPI, the varied presentation and potential for adverse impact on people’s lives underscores the importance of early recognition, thorough assessment, and initiation of comprehensive and holistic/integrative treatment as outlined above. Effective treatment of BPI sufferers can potentially bring a return to a more stable, functional, fulfilling and productive life.

*If you or some one you know is thinking about self harm or suicide, seek help immediately (Call your doctor, 911 or go to a hospital ER, or Call the 24-hour National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).

Article by Ron Parks, MD; edited by Shan Parks

For additional help and resources check below links:

(psych.com/guides)

(dbsalliance.org/)

(NIMH on Bipolar Disorder)

(adaa.org/)

Question:

What would be your consideration and options if you feel that you or a significant other has difficulty with a bipolar illness? I would be interested in your comments.

Lost in Jungle with light ahead

Holistic Approach to Bipolar Illness – Part 1

BPI (Bipolar illness),

often referred to as bipolar disorder or manic depression, affects more than 2.2 million people in the United States. BPI is characterized by bouts of illness with significant often disabling symptoms, alternating with periods of less or no symptoms. These may be a sign of the disorder: unusual shifts in mood, energy or the ability to function.

What is happening to Sarah?*

conflicted young women
©Aleutle/Dollar Photo Club–Conflicted young women.

Because of the insistence of her family and one of her ex-husbands, Sarah had been to several mental health evaluations. She had been married and divorced four times and in and out of many jobs. She had an early life history of trauma: at age 14, she was sexually abused by her divorced mother’s live-in boyfriend; at age 15, she was raped when at a party. She occasionally had nightmares about the incidences and had triggered flashbacks, or panic like attacks, when she smelled certain odors or sounds reminiscent of her rape. She had made several suicidal attempts during recurring periods of severe depression. Hospitalization was required two times when her doctors considered her to be a danger to herself. Her mother and one aunt had a history of bipolar illness. Sarah never had any severe period of mood activation or mania, though one of her treating psychiatrist thought she had periods of what he called hypomania (milder periods of mood, behavior activation or changes). Her diagnosis was Bipolar II type of BPI and PTSD (Post Traumatic Stress Disorder). Her best response to treatment finally came when she received appropriate treatments and therapy for both BPI and PTSD, and when she also sought out the help of a holistically oriented health care provider who encouraged her to follow a more optimal health, nutritional, spiritual lifestyle program.
*(To protect confidentiality, the above is a composite of some clinical experiences and does not represent an actual person or any prior patients).

Sarah’s family and significant others began to pay attention and to take action when her once normal ups and downs of everyday life began to get more dramatic, extreme and destructive.  If you, a family member, or someone you know shows unusual shifts in mood and energy with uncharacteristic behaviors, it may be an early sign of bipolar illness (BPI).

Getting evaluation and treatment when needed.

Evaluation by a trained professional such as a psychologist or psychiatrist should be considered when changes in moods are severe, persistent, and interfering with daily life.  Identify BPI early in its course and treat with a comprehensive, holistic treatment program. If not, the illness can have devastating effects on relationships, careers and health – as was the case of Sarah.

Recurrence of bipolar episodes with depression, anxiety, mania or hypomania has adverse effects on family, social and occupational functioning. BPI disrupts many normal day to day activities in areas as:

  • social functioning and relationships
  • work and productivity
  • sleep and physical health

Recognize bipolar illness in all its forms.

The illness can lead to impaired thinking (cognition), poor judgments, increased distractibility (poor focus), dysphoria (painful moods) and physical discomfort with increased preoccupations with health problems. There can be compromised functioning as with:

  1. more impulsive or volatile behavior and expression
  2. loss of interest, pleasure and motivation in doing things
  3. suicidal thinking.

BPI’s early appearance is often not recognized by significant others or by health-care providers.  A key feature that separates the illness from recurring depression is the occurrence of hypomania or a more severe manic episode.  A manic episode is a period of elevated, expansive or irritable moods, and increase goal-directed activity or energy – often lasting for at least a week – which is a characteristic of the more severe bipolar I type of BPI.

Image of a conflicted brain
©Sangolrl/Dollar Photo Club—conflicted mind.

Other commonly associated symptoms may include:

  • inflated self-esteem or grandiosity
  • decreased need to sleep
  • more talkative than usual or pressure to keep talking
  • flight of ideas or the experience of racing thoughts
  • distractibility
  • increase goal-directed activity
  • excessive involvement in high risk activities
  • marked impairment in social and work functioning
  • sometimes need for hospitalization (if potential for harm to self or others and/or the presence of poor judgement and thought disturbance – psychotic symptoms)

In Bipolar I disorder, the manic episode may have been preceded or followed by hypomania or major depressive episodes. Milder “hypomanic” episodes can have:

  1. a persistent elevated, expansive or irritable mood
  2. signs of sharpened and overly active thinking (hyper-focused)
  3. increased energy and activity that last for at least four consecutive days (present for most of the day – nearly every day)

This “hypomania” alternates with frequent periods of depression and are typical of the less dramatic bipolar II type of the bipolar illness. Recurrent depression is characteristic of both conditions, and the depth of the depression usually determines overall severity.

Both bipolar I and bipolar II types of BPI can be both severe and disabling. Bipolar I disorder more specifically describes a sufferer who has experienced distinct periods of severe depression or hypomania, alternating with at least one episode of severe activation or mania. Bipolar II disorder, by definition, has not had any manic episode.  If mania later presents in bipolar II individuals, this results in reclassification to Bipolar I type of BPI.

Symptoms of Bipolar II have a similarity to those seen in Bipolar I but are often milder, less severe, or more subtle as:

  1. inflated self-esteem or grandiosity
  2. decreased need for sleep
  3. more talkative than usual or pressure to keep talking
  4. flight of ideas or racing thoughts
  5. distractibility
  6. agitation
  7. increase in goal directed, hyper-focused activity (school, work, socially or sexually)

Some subtler bipolar I or bipolar II conditions, at any given time, can present with milder and more difficult to recognize symptoms as irritability, anxiety, and moodiness – alternating with periods of less pronounced depression. Another classification, for the entire range of BPI in its varying expression, is — bipolar spectrum illness —  which would include even the less recognizable forms of recurrent depression with milder periods of activation, hypomania and less dramatic symptoms.

For clear description and definition of BPI, go to the current American Psychiatric Association — the official nomenclature that has been codified and defined in the DSM-5 (published by American Psychiatric Publishing).

What is the cause of bipolar illness and who is affected?

Bipolar illness is considered an inherited condition related to instability in brain neurotransmitters (nerve chemicals) regulation, which leads to greater vulnerability to emotional or physical stress, over-stimulation, upsetting life experiences, drug or alcohol use, and interference with rest and sleep.  The brain is not able to properly calm or activate itself, or restore its usual healthy balance.

Research studies strongly support inherited genetic factors as important contributors to BPI. First-degree relatives of people with BPI are seven times more likely to develop bipolar I type of BPI. Environmental factors (epigenetic factors) are also suspected to affect bipolar illness — physical factors (as radiation or trauma), chemical factors (as pesticides, toxic metals, and air pollution) and biologic influences (as bacteria, mold, viruses).

Lifetime prevalence estimates are 1% for bipolar I disorder — BP 1 type of BPI, 1.1% for bipolar II disorder (BP 2 type of BPI), and 2.4% to 4.7% for sub-threshold BPI (a person is not meeting the full symptom criteria for BP 1 or BP 2). Age of onset range from childhood to the  mid-20s and later, and BPI onset is unusual after age 40. Recurrence of active BPI over a five year period is very common – with the associate in between times of no symptoms, minor symptoms, or with significant residual symptoms. (see  “Bipolar Disorder” by Vinitsky and Parks, Advancing Medicine with Food and Nutrients, 2nd edition, Chapter 32, Dec. 2012, CRC Press)

When can depression actually be bipolar illness?

Recurrent depression is often bipolar illness unrecognized. Additional clues to underlying BPI include:

  • poor response to treatment for depression
  • manic or psychotic symptoms
  • rapid mood fluctuations triggered by antidepressants
  • family history of bipolar illness
  • onset or recurrent depression before the 20s
  • severe premenstrual syndrome, PMS, or premenstrual dysphoria syndrome (PMDS)
  • postpartum depression
  • atypical depression with a lot of irritability, sleep disturbance and anxiety.

At its worst, BPI can lead to higher mortality from suicide and other co-occurring medical illnesses. Among psychiatric disorders, BPI has a significant risk of death from suicide. The risk in bipolar 2 type of BPI for suicide is greater than bipolar 1 type of BPI – according to some studies. Unrecognized co-occurrence of BPI, with other mental or physical illness, can lead to ineffectual treatment and poor outcomes. Six months after suffering a myocardial infarction, victims with major depression – commonly seen in BPI – had six times the mortality rate of non-depressed patients. Presentation of BPI in the older population, greater than 50 years, will often have other medical problems at the time of diagnoses – including cognitive changes. More than 50 percent of people will abuse drugs or alcohol if BPI is not recognized and treated.

Bipolar illness can be overlooked or misdiagnosed resulting in inadequate treatment.

People with this disorder are sometimes misdiagnosed as having just depression, and treated as such, often resulting in a poor treatment outcome.  These individuals would respond better to a bipolar illness focused treatment program. (see for more information)

A holistic or integrative approach to the study and treatment of BPI offers a better path to disease understanding, treatment and prevention of future illness.

Sunset on tropical beach
©Slttltap/Dollar Photo Club—Harmony on a tropical beach.

With a broader open health-care model, there is the potential for improved research, diagnosis and treatment of BPI. All disciplines can be included in an integrative model – including biochemistry; psycho-pharmacology; toxicology; genetics; spirituality; psychology; physiology; endocrinology; sociology; and nutritional, metabolic, environmental, psychiatric medicine and complementary mind/body/spiritual therapies. Effective outcomes can happen with patience and commitment to finding a suitable care and treatment program as occurred with Sarah – as described above.

(For support and assistance consider below sites):

(psych.com/guides)

(dbsalliance.org/)

(NIMH on Bipolar Disorder)

(adaa.org/)

Part 2 of this topic: “Holistic Treatment of Bipolar Illness.”

Article by Ron Parks, MD and edited by Shan Parks

Question:

What would be your first consideration, if you or a significant other is developing signs of bipolar illness? I would like to hear your comments.

Mass School Shooting – Insanity or Guns?

A senseless killing of innocent and vulnerable students has occurred again.

Although the U.S. has about 5% of the world’s population, an estimated 31% of mass public shootings occur in this country. Read More & Additional Info. A mass shooting, gun violence and murder of multiple victims are occurring with increasing frequency in the U.S..  A violent act against the innocent is not supposed to occur in a rational society of laws where there is the supposed respect for the rights and beliefs of others. While compassion and support for the victims and their family are coming forth from the local and worldwide community, there continues to be little movement in public policy to help remedy the situation.

Are the issues with guns or mental health? The standoff between powerful and influential groups with conflicting positions continues while there seems to be little change or constructive action taking place. Perhaps a fresh overview of this tragedy, along with the examination of possible contributing factors, would be helpful. Getting caught up in a “this or that” dialog often  locks people into rigid positions or ideologies that interfere with meaningful action or needed change – a type of “insanity” in itself. How can our outrage and “position taking” channel itself into effective dialog and constructive actions?

Is the shooter a terrorist or a mental health deviant?

Many point at guns and lack of gun control as the main problem while others look at mental health issues – such as the lack of services, non-adequate screening and/or poor identification of an individual who is at risk for acting out in an irrational, violent or deadly way. Some will relate the violence to the lack of mental health services due to a broken or poorly functioning political system in this country or from the indifference of large profit driven corporations.

Many strong opinions get expressed and argued with the recurrence of these irrational, violent acts. While the debate and discussion go on, the victims and their families are left with the emptiness and darkness of loss and despair, from the senseless and merciless act against their loved ones.

Mental health and related societal issues, stand prominently in the center of the controversy.

Tragedy MaskeditEven though lethal weapons – guns – were obviously involved, the recurrent acts of horrific violence towards unprotected populations certainly appear to be insane behavior. People wait for more information about the shooter to be released – with the expectation that there will be something in the mental health history to explain the murderer’s behavior. Significant elements in a mental health history as noted above may contribute to the development of non-normative, dysfunctional thoughts and behaviors that can have tragic outcomes if not recognized and addressed.

According to the 10/3/15 USA Today article, Official: Oregon gunman left angry note glorifying mass killers,  the 26-year old school shooter who killed nine students and himself at the junior college in Southern Oregon was believed to have left behind a rambling statement that glorified mass killing. He talked about his lonely existence with few human contacts outside of the Internet. He also complained about his “isolated life having little promise” and told of an online support group who glorified violence. His note suggested a “bitter and hate-filled” life. If any given individual or groups with these issues or problems are inadequately helped, served, protected or supported – again tragedy can ensue.

The combination of vulnerability; low self-esteem; poor social skills; being a loner; exposure to radical ideas by negative, radical thinking peers or significant others; the media or internet; and so on – is a formula for violent beliefs, perhaps delusional thinking, and the consequences of a person acting on them. The seduction and capture of vulnerable minds do occur when exposed to radical ideology. The results can be the fixation on sets of a non-normative ideas with the development of an inflexible anti-social mindset. The above ideas may give some perspective; however, more is needed to gain a fuller picture of the issues, and importantly – how to move towards some action and resolution.

Guns of course make it easier to inflict harm or kill larger numbers of victims.

If the shooter had more powerful, rapid fire assault weapons with him, there would have been a greater number wounded or killed. Gun laws, access to guns, improving gun control laws and enforcement would certainly be a helpful direction for lawmakers to take with the support of our citizenry, gun owners and the gun industry.

Increasing awareness of mental health issues needs to happen in all sectors of our society including individuals, our government, companies, and corporations that have  much influence on our ideas, consumption patterns and behaviors.

Solution crossroad business concept as a three dimensional maze or labyrinth being erased by two pencils clearing a cross road path for a confused businessman as a symbol for choosing the pathway to success.
Solution crossroad business concept as a three dimensional maze or labyrinth being erased by two pencils clearing a cross road path for a confused businessman as a symbol for choosing the pathway to success.

Ideas for change will hopefully be constructive, adaptive and flexible in order to foster more cooperation, as well as the ability to compromise to bring about new solutions and change. However, when rigidity of ideas set in, strong position-taking happens, and the value of ideas as an adaptive and flexible mechanism of change is lost.

A vulnerable or impaired individuals’ ideas can easily go from being concepts, to becoming an ideology or a fixed rigid belief. There is then the potential for acting on these beliefs, which could result in violent behavior or killing. Our society has drifted towards more radical ideologies – with their propaganda and message – being more easy accessed via media and the internet. Their message has the growing potential to captivate the minds of more of our most vulnerable citizens who often feel unsupported, disenfranchised and left out of mainstream society. There is more appearing of “homegrown” terrorist than ever before.

The influence of ideas and ideologies is similar to what occurs in negative peer groups and gangs violence. The radical Islam and terrorist groups are an example of the same phenomena on an international scale. Our society’s fascination with guns and violence, the notoriety of prior mass shooters and attention given to extreme radical groups in our media has been a definite influence on the radicalization and seduction of the most vulnerable individual in our society.

When mental health issues exist and go unheeded, there can be attachment and adoption of radical, rigid ideas and ideologies.

Vulnerability to radicalization or violent behavior may more likely exist if:

  1. insufficient support in a dysfunctional family or community
  2. overly influenced by media, their personal social network and culture especially when there is a glorification of violence, guns and exposure to an extremist ideology
  3. growing up with rejection, low self-esteem, and social isolation (especially with developmental handicaps and lack of socialization skills as seen in Asperger Syndrome)
  4. marginalized – with the perception that one lacks the ability to fit in or to cope
  5. feelings of being oppressed, bullied or victimized by others
  6. depression with the expressions of hopelessness and helplessness
  7. chronic resentment and anger
  8. exposure to violence
  9. sexual or physical abuse
  10. dysfunctional personality problems with paranoid or anti-social features
  11. paranoid type schizophrenic illness or related impairments
  12. obsessional accumulation of grievances of the wrongs done by others  – see “injustice collectors.”

To the vulnerable, the seductive message is often about revolution, retribution or violence against the perceived perpetrators of suppression or oppression. The message also supports the idea of the indifference and rejection of authority or significant other. There is the promise of gaining notoriety, fame or importance in serving some perceived higher cause.

What moves the young women terrorist to put on an explosive vest, to do a mass killing when she knows that her death is imminent? With the Internet, vulnerable people can find support and encouragement in online forums for radical ideologies. In the past, the extreme and radical ideology of the Nazis regime, for example, captured the support of an entire nation.  The silence and indifference of a majority of the world population at that time contributed to the mass murder of over six million Jews.

So put all these elements together, we have a current growing number of these tragic incidents with the societal problems, mental health and gun issues – persisting.

What to do?

Everyone needs to be in the conversation, including some the rather strongly opinionated, or those who put monetary profits above people.  There needs to be a greater awareness that some of our individual, corporate or government actions may inadvertently foster the climate for growth of more violent ideologies, and further victimization of both vulnerable and actual victims of violence. There are many elements of this crisis to be considered. If you have personal concerns for someone in your life, reach out to a qualified mental health provider – get involved.

Written by Ron Parks, MD and edited by Shan Parks

Question?

Where would you focus your ideas and energy to help make a difference?  I would be interested in your comments.
Picture of a depressed man

The Downside of Untreated Depression

Recovery from most medical illness is difficult unless depression is recognized and treated.

Depression often co-exists with other illnesses. Major depression is one of the most disabling mental disorders in the U.S.. (read more: & see Huffington Post article).  Diseases as diabetes, chronic pain problems, substance abuse, arthritis, hypertension and heart disease are frequently complicated by depression. 

What is wrong with Peter’s father?

Ben, now 67, felt tired, sad and hopeless about life and things in general. He felt blue and empty and cried a lot. He felt cold all the time, with no energy, poor sleep and appetite. He wondered whether life was worth living. His son Peter was becoming more concerned, especially as his father was living alone after the death of his wife one year prior.  Peter had his dad see his family physician who ran some test and referred him to an integrative psychiatrist. Ben was not suicidal, but was felt to have significant depression with associated grief from the loss of his wife. Tests showed that Ben was also severely hypothyroid (low thyroid) and had some nutritional deficiencies from his poor eating habits. He recovered from his depression with his active participation in therapy work and his coming to terms with his losses (death of his wife, retirement from his accounting career). Antidepressant medication was considered but felt not needed with Ben’s rapid improvement. He began thyroid hormone for his thyroid problems and nutritional support for his identified deficiencies.  He joined several community support programs and moved into a smaller apartment which was near his son where several of his friends lived. Peter had offered his dad a place to live with his family, but Ben prized his independence and felt positive about getting back on his own two feet again. *(To protect confidentiality, the above is a composite of some clinical experiences and does not represent an actual person or any prior patients).

 Effective identification and treatment of depression may bring:

Depression is costly to everyone.

Health care money spent for depression in the United States, plus the cost of lost work, is enormous.  Effective intervention for depression, when occurring with substance abuse or medical problems, lowers health care costs. (read more “Economic Impact of Depression” )

Depression can clearly predate a medical or addiction problem. It may also occur as a reactive response to illness related stress. Depression can also relate to the physiology of the illness or to the treatment interventions or medications. In neurological conditions such as Parkinson’s disease, multiple sclerosis, Alzheimer’s disease and strokes, the lifetime prevalence of depression is 30 to 60 percent*, compared to a much lower percent in the general population.

In diabetes, the lifetime prevalence of depression is double to triple that of the general population. It can cause increased insulin requirement and increase the risk of diabetic complications. People with coronary artery disease and depression are estimated to have a 40 percent* higher risk of having a cardiac event. Depression increases the risk of death from a heart attack five-fold* and is a significant predictor of disability one month after a heart attack or one year after coronary bypass surgery. Estimates of depression and cocaine dependence range from 33 to 53 percent*. Estimates of depression in alcoholics seeking treatment range from 15 to 67 percent*. Those who are dependent on opiates have rates of depression estimated as high as 75 percent*.    ( read more & also to see additional information )

dep word laufer sizedEarly diagnosis and treatment of depression is critical in preventing and alleviating sickness, suffering, and possible death. Some studies suggest that in primary care settings, 30 to 50 percent* of depressed patients go unrecognized – and only about 20 percent* of those recognized receive adequate treatment. Health care providers, friends, family and employers all need to make a greater effort. Community education about key signs of depression is important.

Symptoms of depression include:

  1. loss of interest or pleasure in doing things
  2. often feeling down, hopeless or sad
  3. trouble sleeping or sleeping too much
  4. feeling tired or having little energy
  5. poor appetite or overeating
  6. frequently feeling bad about yourself
  7. trouble concentrating
  8. slowing down of speech or movements
  9. being fidgety or restless more than usual
  10. thoughts of dying or of hurting yourself
  11. difficulty functioning at home, work or getting along with people.

When suicidal feelings, thoughts or statements occur, get immediate help and assessment from a qualified mental health professional or resource. In U.S. for help, call 1-800-273-8255 for the National Suicide Prevention Lifeline.

An integrative approach to treatment gives the best chances for improvement or recovery.

Identification and treatment of contributing factors can be as important as taking an antidepressant medication or other remedies. Consultation, which may include specialized testing, may uncover:

  • hormone deficiencies such as hypothyroidism
  • deficiencies in nutrients as B12, folic acid, minerals, amino acids or essential fatty acids
  • toxic environmental exposures such as to mercury or lead
  • environmental illness such as allergies to mold
  • food sensitivities as to wheat, gluten or diary
  • other medical or addiction problems

People with depression, beyond simply taking an antidepressant pill or a natural remedy, can benefit greatly from social support, psychotherapy and other complementary approaches. Seek out help from qualified health professionals when needed – preferably those with a holistic orientation. Learn as much as possible about depression by seeking information, reading, or attending educational programs or support groups.

*(some statistics noted above are from Dr. Parks prior research on this topic without specific references given here, however, some recent articles and statistical references are presented in the links above)

Article by Ronald R. Parks, M.D.,  edited by Shan Parks

Question:

If you or a significant other has signs of depression, what would be your concerns and first steps to take? I’d be interested in your comments.

Best Treatment For Panic and Anxiety

Prevent and reduce the frequency and severity of anxiety and panic.

A high percentage of panic attack suffers receiving appropriate treatment will be able to prevent and substantially reduce the frequency and severity of panic episodes. Cognitive behavioral type of treatments is often beneficial. This approach can help retrain and recondition an individual to reduce stress and anxiety. Therapy of this type may include:

  1.  intensive education about the disorder and of the body’s physiological reaction to stress and threat
  2. desensitization to the various physical sensations or triggers of panic through exposing a person to the actual object, situation or thought
  3. catastrophic thought reducing techniques
  4. learning relaxation, proper breathing to prevent hyperventilation and stress management techniques
  5. restructuring dysfunctional thoughts and patterns

Any contributing problems would need attention as:

  • substance abuse and the use or overuse of stimulants (drugs, caffeine and smoking)
  • post trauma or depression
  • environmental problems
  • allergies or reactivity to chemical and toxins

Evaluation, treatment or elimination of any related problems or contributing factors would be the first consideration. Natural alternatives and therapies can then be considered as:

  • mind, body or spiritual practices as yoga and meditation
  • stress and relaxation techniques
  • massage
  • acupuncture
  • herbal medicine, nutrition, vitamins, minerals, essential fatty acids and hormones can complement more traditional treatments
  • correcting deficiencies of amino acids (the smallest units of protein and the precursors of brain neurotransmitters) can sometimes be helpful in relieving anxiety – can be used alone or sometimes in conjunction with medication

If any history of severe depression or suicidal thought seek mental health services and a qualified therapist or psychiatrist. If there is a history of trauma or post traumatic stress disorder symptoms, some specific therapies may be helpful: Cognitive Processing Therapy or Prolonged Exposure Therapy, EMDR (Eye Movement Desensitization and Reprocessing), EFT (Emotion Freedom Technique) and Somatic Experiencing Therapy.  If evaluation or monitored treatment is needed for any of these issues, seek help from a qualified, holistic oriented, health care practitioner. (read more on complementary treatments)  (read more on PTSD)  (About Integrative Psychiatry, Medicine & Holistic Therapies)

 Medication may be of value in resistant or severe panic disorder.

women panic sizeAntidepressants as Paxil, Zoloft, Effexor, Prozac, MAO-Inhibitors, and tranquilizers as Buspar, Xanax, or Klonopin are used and sometimes bring more immediate relief. However, their long-term use is controversial with the concern for their possible cause of other medical issues and also because the withdrawal from them can be difficult. They may not have the same lasting effect as the retraining and reconditioning that takes place with the cognitive behavioral type of treatment, appropriate therapy work and the use of natural alternatives.

Try some of the following techniques to help calm the body and mind.

If not helpful or you recognize the need for skilled or professional help — seek a holistic oriented health care provider with expertise and training in the area of anxiety, panic and mood disorder treatment.

Stop all stimulants like caffeine or stimulant drugs • Notice and let go of fear-based thoughts and worries from the past or concerns for the future • Change your physical space: move to a quiet room or just adjust your posture to a more comfortable position or find a more cozy place to sit or lie down • Turn on some soft, pleasurable music • Notice and shift your attention to comfortable, physical sensations, passing through your awareness • Be aware of your breath: see if you can relax it into an even flow of in and out breaths • Center yourself: think of your whole-self as being enveloped in a loving warm cloud • Imagine a favorite place or moment that reminds you of peacefulness, warmth and total acceptance • allow yourself to accept “what is as is” including yourself in the timeless now moment • Feel completeness and contentment.

Meditate: Focus on the quietness and peacefulness of your breathing • carry yourself into deeper relaxation by releasing your mind from any remaining fears or concerns, or any feeling of mind or physical tension • keep a relaxed focus on any tension or thoughts that come up and let them go • coming back to the peacefulness of the eternal now • after a few moments take a few deep breaths and slowly open your eyes if closed • give a gentle stretch, and feel the peacefulness and relaxation • gently return to your daily tasks as a renewed spirit.

Take a yoga, chi gong, meditation class, and have a regular routine of exercise to do daily • Go outside and embrace nature • Do something caring or helpful for someone else • Drink calming herbal tea like chamomile • Take a relaxing herbal supplement like Valerian root, passionflower or amino acids such as Taurine, L-Theonine, or GABA • Add magnesium and calcium to your supplement regime • Take a warm bath or sauna • Get or give a massage • Call a supportive or nurturing friend • join or establish a supportive group or network • Go out and do some volunteer work or work in the garden • Spend time with a loving pet • Read a spiritual or inspiring book or poem • Eat some healthy organic vegetables or fruit • Take care of yourself!

If any of above discussion about anxiety or panic seems to apply to you or family member, and you are concerned, reach out for help, and get the support and direction you need. (a resource ADAA)  (Consultations)

Article by Ron Parks, MD and edited by Shan Parks September 2015

Question:

What is your next step to help yourself or others who seemed troubled with anxiety or panic??

Help for Anxiety and Panic

Has anxiety and panic attacks compromised your life?

Peace of mind and personal happiness may elude sufferers who deal with significant anxiety or panic attacks. You may discover that you are one of the many who find these issues replacing life plans, career, social and personal needs with pain and fear. Then you watch a TV commercial, hear a radio advertisement or read ads offering products, pills and all types of remedies for relief. Amidst all this, how do you sensibly choose the best way to get help or relief?

Barbara* a 30-year-old radiology technician, walking to her bus stop after work, was startled by an unexpected, overwhelming feeling of terror and panic. She felt flushed, lightheaded and dizzy. There was a weird sensation of chest constriction and difficulty breathing. Her heart raced and pounded in her chest. Thoughts of dying, losing control, or of going crazy flashed through her mind. With each wave of fear, her heart began to pound even louder. Her hands now felt sweaty, numb and tingling. There was a sense of unreality about things. A friend, noticing her distress, approached, and helped her to a bench near the bus stop. Over the next 5 to 10 minutes the feelings gradually subsided. Feeling some relief, but still shaky, her friend helped her to the nearby hospital emergency room. *(To protect confidentiality, the above is a composite of some clinical experiences and does not represent an actual person or any prior patients).

 Barbara had just suffered a panic attack – a type of severe anxiety.

Unlike the brief and mild anxiety caused by a stressful event, the more severe anxiety disorders are serious medical illnesses. These affect approximately 40 million adults, 18% of the population, age 18 years and older — one in four adults in the U.S., at least once during their lifetime. Anxiety disorders cost the U.S. more than $42 billion a year, about one-third of the country’s $148 billion mental health budget. An estimated 75% of people with an anxiety disorder have at least one other accompanying psychiatric condition. See: http://www.adaa.org/about-adaa/press-room/facts-statistics

These disorders cause overwhelming, even debilitating, anxiety and fear that can become worse if not treated. Less than 30% of individual with these problems seek treatment, and many go undiagnosed by their primary care physicians. Common signs and symptoms of anxiety include muscle tension, trembling, fast heartbeat, fast or troubled breathing, dizziness or impaired concentration, palpitations, sweating, fatigue, irritability, and sleep disturbances.

Panic disorder, a type of severe anxiety, is estimated to affect over two million adult Americans, and is twice as common in women then in men. The lifetime prevalence of panic disorder in the U.S. ranges from 1.5% to 3.5%.  Symptoms of a panic attack include feelings of terror that suddenly strikes.  An episode can occur as a one-time event only or can repeatedly happen, triggered by something remembered or appear without warning — out of the blue.  Panic can cause waking at night; a pounding or racing heart; sweaty, nausea, numbness, tingling, weakness, faint or dizzy feeling. There can also be a sense of unreality; chest pain; fear of impending doom, of going crazy, of losing control; and avoidance of going to certain places. See: Advances in the Treatment of Anxiety Disorders

Panic attacks are both unique and common.

Pannic Attack - the Words in White Color on Cloud of Red Words on Orange Background.

As many as 20% of American’s are affected at least once in their lifetime. Considered one of the most distressing conditions that a person can experience, early recognition and proper treatment are important. Many of the symptoms reported by Barbara above are typical of panic attacks and are considered to be major health problem in the U.S..

Panic is different from fear and other types of anxiety – as panic attacks are unexpected. They are often unprovoked, appear suddenly and increase in intensity over a 5 to 10 minute period, peaks and then rapidly goes away over 20-30 minute period. These episodes can be disabling. One explanation for the cause of the panic disorder is the bodies normal alarm system of mental and physical responses to an actual threat, which triggers and activates to a non-actual threat. Panic increases in severity by hyperventilation or focusing on catastrophic thoughts or fears.

Panic disorder – as in most types of anxiety – affects women more than men, often begins in the 20’s and 30’s, and appears to be more common in some families. Sometimes an initial episode might be related to some identified causal or contributing factors:

  • Actual or transient medical problem as a middle ear infection, allergies, mitral valve prolapse (often a mild dysfunction of this heart valve closure), hyperthyroidism, low blood sugar
  • Earlier life history of significant trauma or post-traumatic stress disorder
  • Medications use or withdrawal, stimulant or substance use, or abuse (caffeine, alcohol, opiates, etc.) in a predisposed person who is vulnerable to panic attacks
  • Life events involving major stress, losses, threats of loss or the feelings of increase vulnerability may precede attacks

The panic disorder once rooted can become recurrent and chronically disabling.

If the panic attack occurs in a specific setting, as in a store or car, irrational fears or phobias about these situations, may occur. If a person begins to avoid these situations, he (or she) can become increasingly housebound, unable to drive and develop agoraphobia (fear of public place) in addition to the panic attacks. If the person doesn’t receive effective early treatment, major incapacitation may develop.

Panic disorder mimics many other medical conditions, and it is not unusual for the sufferer to be seen by a multitude of other medical or health-related services before receiving appropriate treatment. They will often go through extensive testing at great cost. The reassurance that “nothing is wrong that’s serious,” or “it’s all in your head,” doesn’t help. Medical personnel – not familiar with the potential ravaging effect and disability caused by the illness – often treat panic disorder lightly. Treatment of panic is often done with a mild tranquilizer or just reassurance. Dr. Weissman and Associates on November 2, 1989, New England Journal of Medicine, clearly point out the need for concern.  Compared with other psychiatric condition, untreated panic disorder has an increased risk of suicidal ideation. There is an almost three-fold increase in actual suicide attempts, independent of coexistence of major depression, alcohol or drug abuse or agoraphobia.

Recovery starts with the person deciding to seek help, treatment and a more life-affirming path. Hindrances that may need attention early on could include:

  1. Medical illness
  2. Developmental impairments
  3. Dysfunctional patterns of behavior
  4. Rigid beliefs
  5. Lack of social support.

Change happens with:

  • Willingness for self-examination without blaming or taking the victim’s role
  • A commitment to positive action and to the beneficial treatments that are available
  • Gaining awareness and opening up to new knowledge
  • Becoming a more discerning consumer of health information and available care
  • Developing the motivation to take effective action for necessary changes

For more information see:

Holistic approaches to anxiety and panic may include a combination of:

  1. Combination of conventional medications
  2. Lifestyle modifications and life skill education
  3. Alternative holistic treatments
  4. Targeted nutritional applications
  5. Psychotherapeutic interventions
  6. Enhancement of awareness and spiritual practice

Through an integrative approach, individuals can gain direction, move past the immobilization of misinformation and erroneous beliefs, and find possible solutions for their adverse health conditions.

Click here for more information;   Another Resource to read; 
For support: Anxiety and Depression Association of America, ADAA

Article by Ron Parks, MD and edited by Shan Parks September 2015

Question:

What is your next step to help yourself or others that seemed troubled with anxiety or panic?  See next post — “Best Treatment of Panic and Anxiety?”

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