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feeling misunderstood - a symptom
of childhood depression
Depression in Children
Only in the past two decades has depression in children been taken very seriously. The depressed child may:
- pretend to be sick
- refuse to go to school
- cling to a parent
- worry that the parent may die
Older children may:
- sulk
- get into trouble at school
- be negative
- grouchy
- feel misunderstood
Because normal behaviors vary from one childhood
stage to another, it can be difficult to tell whether a child is just going thru a temporary "phase" or is suffering from
depression.
Sometimes the parents become worried
about how the child's behavior has changed, or a teacher mentions that "your child doesn't seem to be himself." In such a
case, if a visit to the child's pediatrician rules out physical symptoms, the doctor will probably suggest that the child
be evaluated, preferably by a psychiatrist who specializes in the treatment of children.
If treatment is needed, the doctor may suggest
that another therapist, usually a social worker or a psychologist, provide therapy while the psychiatrist will oversee medication if it is needed.
Parents shouldn't be afraid to ask questions:
- What are the therapist's qualifications?
- What kind of therapy will the child have?
- Will the family as a whole participate in therapy?
- Will my child's therapy include an antidepressant? If so, what
might the side effects be?
The National Institute of Mental Health
(NIMH) has identified the use of medications for depression in children as an important area for research. The NIMH-supported Research Units on Pediatric Psychopharmacology (RUPPs)
form a network of 7 research sites where clinical studies on the effects of medications for mental disorders can be conducted
in children & adolescents.
Among the medications being studied are antidepressants, some of which have been found to be effective in treating children w/depression, if properly monitored by the child's physician.
 
Childhood Depression & Bad Parental Habits
By: Peter S. Jensen, MD
A study by researchers at Columbia University in New York City reported
that bad parenting may put children at a higher risk for anxiety & depression.
The investigators
interviewed nearly 600 parents & their children, & results showed that poor parental behaviors - like verbal abuse, inconsistent rules, parental arguments in front of children & a lack of supervision - can all increase the chances of
childhood anxiety or depression.
Surprisingly, studies show
that up to 2.5% of young children & 8.3% of adolescents in the US suffer from depression. Child psychiatrist Dr. Peter Jensen looks more closely at some of the symptoms & treatments for this difficult condition.
Q: Are there certain types of children who are
more prone to depression?
We think that family history is important, so genetic factors probably play a role. But there are other factors that are also suspect.
Prolonged medical
illnesses might serve as a precipitant, or stress factors occurring throughout a substantial period of one's life. Some people have demonstrated that the loss of significant loved
ones in early critical periods - In the first 5 years of life - might lead to a modest increased risk for depression.
Another that is
also linked to depression is substance use. Prolonged substance use is probably
linked to depression as well.
Q: Do you mean substance
use by the child or by the mother during pregnancy? Both.
Q: Is depression more prevalent in girls or boys?
The prevalence of depression in boys & girls is equal prior to puberty. The rates are not particularly high - maybe 2% or so - in that range. But
when they hit puberty, unfortunately girls really seem to blossom as far as depression is concerned.
At that point
it probably doubles or triples among girls, whereas the rate among boys only increases modestly. We don't know if it's due
to pubertal hormones, the new stress factors that occur to girls as they reach puberty & face other responsibilities or male / female differences in societal expectations.
There are a lot
of issues regarding weight concerns & body image that also might contribute.
But again, if it looks like
the child is depressed - if there's easy, frequent irritability or tearfulness, talking about death or suicide, loss of interest in normal
activities, decline in grades, staying alone in one's room for long periods of time - these would all be warning signs.
Q:
If your child is diagnosed w/depression, what sorts of treatment options are available?
A: Well there
are two major forms of treatment. Some of the newer medications are called SSRI's. It's a fancy term, but SSRI's, antidepressants
like Prozac or Zoloft, work on a different chemical in the brain than some of the older style medications. They are quite
safe & highly effective in adults. We are now seeing evidence that they appear to work now in adolescents as well.
The other form of treatment
that we think works well in children is something called cognitive behavior therapy, or CBT. It's a special therapy that combines
the two different disciplines of behavior & cognitive therapy.
Q: What would be your advice to a parent who suspects their
child might have depression?
The first thing I would do
as a parent is educate yourself & speak w/a primary care provider - the child's pediatrician or adolescent medicine specialist.
Frequently they'll know resources within the community which can help. You need to be armed w/good information about what
works & what doesn't.
- Don't make the child's pain
seem unimportant.
"Everybody suffers. What makes you so special?"
"Why don't you grow up?"
"Stop that. You're driving me crazy."
When people
feel bad, they feel that their pain is so bad that no one can really understand it. That's why a person who is hurting would probably rather have you say:
Sometimes the best way to
show understanding is to admit that you can't understand just how bad a person feels.
Showing understanding to a child may be especially difficult for parents. We tend to think it's our job to correct & change our children. Consider the example of spilled milk.
When a child spills milk at
the table, it's common for parents to become angry. Sometimes we give them lectures about being more careful. Sometimes we even call our children names like "clumsy" or "stupid."
Lectures & name - calling are likely to make the child angry or hurt.
How can we show understanding when a child makes a mistake like spilling milk? One way is to simply say, "Oops. Will you get a towel & wipe up the
spill, please?” By avoiding lectures & insults, we are showing respect for the child's feelings.
Insulting lectures don't help children do better next time they have milk. They may even make the child more nervous
& more likely to spill it.
Another message of understanding is: "It's easy to spill a glass of milk. All of us do it some time. Please get a towel & wipe up the spill." Children
need to know they can make mistakes & still be loved & accepted.
Sometimes it's hard to show
understanding because we feel angry when the child makes a mistake. When we're afraid we might say something mean, we are wise to be quiet until we feel less anger.
How can I show understanding & still discipline my child?
Sometimes it’s hard
to deal w/our children because we're angry or tired or lonely. We don't have any love to give our children. If that's true, we need to find ways to strengthen ourselves. We may need to have time w/our friends or time for our hobbies. It's hard to give love when we feel empty. See Extension Circular HE-674 in this series, "Taking Care Of The Parent: Replacing Stress
With Peace."
Take time to listen to children's feelings. Understand. Remember that what the child is experiencing is very real to the child. Don't try to discuss problems w/the child when you're
angry.
Regularly ask the child about
her experiences. "What was school like today?" "How did the test go?” "What was the happiest thing that happened today?" Ask questions. Listen.
Remember that each person
is different. You may have one child who cries over every experience. You may have another who keeps all feelings inside. Each child may need understanding in a different way. But each child needs understanding.
Help the child understand other people's feelings. "How do you think Mary felt about her dog being lost?" As you discuss feelings, try to understand what the other person feels.
Once a child feels understood, she's more likely to accept correction. She's more likely to want to obey.
Susie has had
her cousin Carol w/her all summer. Now Carol has gone home. Susie comes in whining about how she'll miss Carol.
How do we usually react in such a situation? Many parents would say something like: "You'll
get over it." "You'll make more friends." "Stop whining." "Don't be a baby."
Do these statements show understanding? How will they make the child feel? Can you think of some things to say that will show more understanding for Susie? What do you think of the following statements:
"I can see that you'll be lonely w/out Carol."
"The house must seem empty now that Carol is gone." "When you spent so much time together, it's hard to be apart."
"Carol has just left, but already you miss her."
Do the above statements show Susie that you understand her feelings? Would you feel comfortable using one of them?
Sometimes we think it's our job to help our children "get better" or get over their hurt feelings. But if we correct them ("Stop being a baby. You'll make new friends"),
they may feel that we don't understand & don't care about how they feel.
When we take time to understand ("I can see you'll be lonely without Carol"), they're more likely to feel that we care about them. Understanding & caring help them to feel better & help them to think of solutions for their problems.
What about these situations?
What would you say if your 6-year-old Tommy said, "You're a rotten mother.
I hate you!" A first reaction might be to become angry & punish the child. Or you might argue w/the child:
“You don't know what you're talking about. I'm the only mother who
would put up with you."
Or a parent might feel sad & cry.
What could you say to show that you understand the child's feelings? You might say: "You seem to be very angry right now. I can understand that. I would like us to talk more about your feelings when you don't feel so angry."
Here's another situation: Your son comes home w/a note that he's in trouble
w/the bus driver. What are you likely to say? What could you say that would show understanding? Try to think of some ways before you read further.
If you take time to understand that he might feel embarrassed or angry, then you're very understanding! Of course, after he feels understood, it's a good idea to ask him what he can do to be sure he won't get in trouble w/the bus driver
in the future.
It's not useful to blame either the boy or the bus driver. First, understand. Then, after he feels understood, discuss ways to prevent further trouble.
When parents use active listening, they help their children feel understood.
'My
little sister gets on my nerves. How can I control my feelings?'
She
is five, but she really gets on my nerves sometimes & I end up shouting at her. Then I get told off. I have a little
bro or sis being born very soon & I really do want to be nice. It's just really hard. What do I do?
Jon,
14.
our online advisors reply:
At
your age you're probably going thru puberty. This is the time between childhood & adulthood when various changes
take place. You're probably aware of the physical changes that occur, but this is not all that happens. This is also a stage
of emotional development, which many young people find confusing. Emotions can be very intense & unpredictable. Feeling worthless, ignored & misunderstood are common at this stage.
Understandably,
this can be difficult to handle at times, but the good news is that this doesn't last forever.
Sometimes
when we feel frustrated or have feelings that are so big & difficult to understand it can be really difficult to stop ourselves from being angry. These feelings become even stronger when we are tired & stressed because it makes us more vulnerable.
Getting
upset with our little brothers & sisters is very common no matter how much we love them. It sounds like you're worried that you might shout at your new brother or sister. Perhaps it might help if you helped
your mum out a bit with the new baby. Babies can't do anything for themselves & a lot of your mum's time will be taken
up but this doesn't mean she loves you any less. By helping out you will get to spend time with your mum & your new sibling & I'm sure your mum will
really appreciate it.
When
you play with your little sister or talk to her & feel yourself getting frustrated & angry, try to walk away & do something else for a bit while you calm down. If it isn't possible to walk away, for example if you were looking after her, take a deep breath a slowly count to
10 until you feel less like shouting.
Perhaps
you could talk to your mum about how sometimes you get angry & you don't mean to. Talking to your mum when you feel calm might help. When you do, you could offer how you're feeling & what's going on for you.
If
you'd like to talk to someone else about how you're feeling other than your mum you can call ChildLine on 0800 11 11. This is a free telephone number where you can talk to someone in
confidence 24 hours a day. No one will tell anyone that you have called. The number can be busy so do keep trying.
Some
websites that might give you a few ideas to control your anger are:
I
am the type of person that needs directions for everything. Isn’t there some way of getting instructions on how to be an open & honest patient without causing a total meltdown of emotions?
Psychotherapy
can often have an exhilarating intellectual satisfaction to it. In fact, much of the material on this website has an intellectual flavor. But there is a big difference between describing
psychotherapy & practicing psychotherapy, because good psychotherapy is primarily an emotional process. Without the emotional
basis to the work, the intellectual discoveries have no real, practical value.
Imagine
having to undergo a painful medical procedure. You can research it until you know everything that's going to happen &
you can say, “OK. I’m ready. I know what to expect.” Well, knowing is one thing, but when you feel the real pain it will be a different matter altogether.
And
as I say on other pages, during the psychotherapeutic process you'll experience many emotions that are similar to the intense & confusing emotions you felt as a child.
Many
different events - some of them just chance occurrences during therapy & some of them deliberate therapeutic interventions
by the therapist - will trigger these emotions. Just remember that when you feel an emotion in therapy, the therapeutic task will be to name it as an emotion & understand it as an emotion - not get caught in it as if it were your helpless destiny.
For
if you get caught in it, you'll & feel like a victim will blame the therapist for your pain. The entire therapeutic process will feel like judgment & criticism. And then, in deep bitterness, you'll want to “get away” from the therapy just as you wanted to get away from the original emotions as a child.
Maybe
something happens in the psychotherapy & you feel abandoned. So instead of impulsively acting on that feeling by doing something to control things & protect yourself (e.g., punish yourself, or terminate the psychotherapy), just sit with the feeling for a while.
Understand that the psychotherapist (at least, a competent psychotherapist ) isn't there
to hurt you but is there to help you learn. So just say to yourself, “OK Self. We feel abandoned. But it’s not really abandonment, it just feels like abandonment. So how have we ever felt like this before? When did it happen?
Under
what circumstances? What did we do? What are the similarities across different events? What can we learn about our
past behavior from this feeling that's happening now? What can we see now by examining the feeling with curiosity that we couldn’t see then when we just blindly reacted to the feeling?”
There
can also be times during psychotherapy - for example, when you're working on recognizing suppressed anger at your parents - that you'll feel oversensitive & ill-humored outside the therapy setting. You can come close to losing your temper with everyone. You'll feel “flashes”
of anger. Your thoughts will seem irrational. So what do you do?
Well,
just go ahead & be irritable. You won’t be able to stop it anyway even if you try.
But,
while you’re in this mood, don’t make any rash decisions, such as deciding to quit your job.
After
you cool down, make appropriate apologies to everyone you have offended.
And
then tell your psychologist about everything in your next session so that you can discover the real source of the anger behind your irritable mood. Most likely it was anger being displaced from some childhood experience.
Now, as your question shows,
in addition to your conflicted fear of your emotions, you also have a healthy fear of your emotions. After all, if everything came pouring out of you at once it would be a psychological disaster. But thankfully the unconscious,
when treated with respect, has a way to protect you.
Dreams, for example,
tell you only what you need to know, as you need to know it & as you're capable of knowing it. Even the experiences you have in psychotherapy are given out in healthy “doses” by the unconscious.
All that matters is that you & your psychologist have a healthy respect for the dosing process.
As an example, let’s assume that for some reason you decide to go on
a sudden short trip. You call to cancel your psychotherapy appointment the next day. When you show up at your next appointment
the following week, your psychologist tells you that when you canceled your session, you gave only 23 hours of advance notice,
rather than the required 24 hours notice & so you must pay for a late cancellation.
You don’t say anything, but when you get home you send an angry e-mail to your psychologist saying that most people understand “24 hours notice” to mean “about 24 hours,” & that you can no longer trust therapy & so you have no choice but to terminate therapy.
OK. Now let’s follow out a different outcome. Imagine that when you
get home you’re feeling miserable & shaky. You’re hurt, but you don’t quite understand it all. You feel distracted the rest of the week & have minor conflicts with everyone.
But, because you're committed to your psychotherapy, you show up for you next session. And you begin the session by complaining about how poorly you've
been treated by your husband (or wife, or boss, or whomever).
And you mention an example about a dispute over money. Suddenly, your psychologist
interrupts you & reminds you about the late-cancellation fee & asks what sort of reactions you had to it. You hesitate.
But then you start talking. You describe how you went home last week &
got drunk. You talk about how you thought of stopping therapy. Your psychologist asks for more associations & before long you’re describing how your father
used to make rash, arbitrary decisions & how you always felt angry but never said anything. So you'd secretly do something self-destructive, like purposely fail an exam in school.
Your psychologist keeps probing. What did you hope to accomplish by failing an exam? Well, as you ponder it, you realize you wanted to show your father how much pain you felt....And on it goes, for
the rest of the session. If your psychologist is really good, you'll also encounter the very self-destructive impulses that led you to make that provocative 23-hour cancellation in the first place.
So what do you learn from this? Well, you learn about feelings of hurt, anger, helplessness & revenge. You learn how your current behavior is connected to your past behavior. You learn how in the past you failed to recognize your own emotions. You learn how to speak honestly about your inner experiences to another person. And you learn how irresponsible behavior flows directly from the failure to recognize your own emotions.
And you learn that you can
encounter your emotions in measured doses that are far from that dreaded meltdown. It all depends on your willing choice to make an honest commitment to the psychotherapy process, however painful or frightening it might seem. Because as you let off the heat bit by bit, it can never build to the melting point.
"How can I get my husband to listen to me?"
When
I have a problem I want to share with my husband, he jumps in & starts telling me what I should do & how I
should handle the situation. How can I get him to listen, without immediately telling me what to do?
This is a question I receive from many women. When women have a problem
or feel distressed, we often need to vent & process our feelings before we're ready to work on resolving the situation. Men, on the other hand, like to jump in & resolve the problem
immediately.
Try to keep in mind that your husband is trying to be helpful. However, his attempt to be helpful leaves you feeling unheard, misunderstood & possibly resentful, particularly if he uses a controlling or dictatorial approach.
It feels like a no-win situation because since you aren't ready for advice yet, you may rebuff his suggestions
which, in turn, makes him feel rejected & confused.
Here's
what you can do in the future:
Before
you begin the conversation, let him know exactly what you need from him. You might say something like, "I want to share something with you that happened today, but I'm not ready to work
on resolving it yet. I just need to vent right now."
Opening
your conversation in this way gives him the clarity he needs & helps him understand what you want. It'll also give him an opportunity to improve his listening skills. It's possible that your husband, even with your clear instructions, will not quite understand the purpose of the conversation. He may even say something like, " Well, if you're not going to do anything about
it, why talk about it?"
If this
happens resist the urge to get angry & take a moment to help him to understand. Tell him, "I do plan to do something about it & I'll probably be asking for your opinion in a day or so, but right now what I need to do most is express my feelings & know that you support & understand me."
In time
your husband will become more comfortable with his "listening" role in these situations. But since new behaviors take some time & practice to learn, being patient with him will smooth the process & make it easier for him to learn.
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Choosing Child-Free
Adults Who Don't Want Kids Grow in Number But Feel Misunderstood
By
Geraldine Sealey - Feb. 14
When Ellen Metter was a young
girl, she didn't go for the baby-doll thing. She dressed her Barbie up as Mary Tyler Moore - a single, urban professional
w/her own imaginary apartment & fun date nights.
"She was hip," says Metter,
author of the recent humor book Cheerfully Childless. Now Metter, 42, wonders if her young
lack of interest in nurturing dolls foreshadowed her adult lack of desire to have children.
Like many women who decide
against children, Metter says she questioned her leanings on occasion - either thru her own self-exploration or others' prodding questions. When she met her boyfriend a few years ago, she thought she wanted to have kids w/him because
it seemed like the ultimate expression of their love. But the couple eventually decided against it.
"My boyfriend has great genes,
he's handsome, we'd make an adorable child," Metter says. "But then again, Hitler had parents."
Humor has helped Metter communicate
w/others about a topic she says is misunderstood by a family-oriented culture. "It's not
right for me," Metter says. "And if you're like me & never had this visceral attraction to kids then it's probably not
right for you either."
Indeed, more people are deciding
kids aren't for them as the ranks of the childless continue to swell.
Although a government report
released this week showed American women having more children than at any time in the last 30 years — in many cases,
a good economy made it easier for women to have additional children — more women are also postponing childbearing or
foregoing it all together.
Of women ages 40 to 44 years
old, near the end of their childbearing years, 19% are childless, the U.S. Census Bureau reports — a number almost twice
as high as 20 years earlier.
While those statistics include
women who would like to have kids or are infertile, more women say they're childless by choice.
Nearly 7 million women of childbearing age defined themselves as voluntarily childless in 1995,
the latest year available, up from 2.4 in 1982, according to the National Center of Health Statistics.
Shunned & Misunderstood
It's no coincidence that voluntary
childlessness is on the rise as women are becoming more educated & eligible for a wide variety of opportunities outside
of family life, says Madelyn Cain, author of the book The Childless Revolution.
Childless couples tend to
be a more educated & affluent group than their counterparts w/kids. With no child-related expenses to shell out, childless
couples have more disposable income to spend — 60% more on entertainment, 79% more on food & 101% more on dining
out than parents, according to American Demographics magazine.
Despite their growing numbers
they're ignored as a legitimate interest group & consumer class , many childless individuals & couples complain that & even shunned
by society for their lifestyles.
"We
are w/childlessness where we were w/homosexuality 20 years ago," Cain says. "We always talk about family-friendly America.
It's always part & parcel of a politician's package. But the package they're selling doesn't match the general public."
Those who are childless say
they get all sorts of unwelcome & unfair, observations from strangers, family, friends & co-workers alike. They're told they are: Self-centered, deviant, workaholic, immature & child-haters.
In reality, Cain said, the
reasons people are childless are varied & complex: Some have environmental, religious, medical or professional reasons.
For others, it's a matter of happenstance — they didn't meet the right partner or the time just never seemed right.
Child-Free: More
Selfless Than Parenting?
Some particularly rabid Web
sites devoted to the "child-free," as many like to be called, refer to parents as "breeders" & condemn procreation in
general, but they seem to be in a vocal minority. Most who are childless by choice say they respect parents & enjoy children. They just know parenting isn't for them.
A lack of understanding about the choice to be childless can be annoying when it comes from acquaintances & downright devastating when it comes from loved ones, Cain said.
"When your mother says, 'You're
gonna regret it,' if that doesn't send a chill thru you or wake you in the middle of the night …" says Cain, who interviewed 125
childless women for her book. "Those are terrible things to hold over someone's head."
Lisa Casablanca Simmons, 36,
knows what it's like to be poked w/questions about the choice she made as a teenager not to have children. Married for 14
years, Simmons said her husband's family first thought she was selfish.
But Simmons sees her decision
as rooted in not just honest self-assessment — she thinks she would make a "terrible mom" because she's not very patient — but also selflessness.
"Isn't it selfish to bring an unwanted child into this world?" says Simmons, who lives in Los Angeles. "We're doing right by not bringing an
unwanted child into the world."
Finding a Substitute
for the PTA
For Kathleen Sartoris, 32,
of Queens, N.Y., choosing not to have children also was part of an honest & in her view necessary, prioritizing of her life.
"I am sure I will miss out
if I never have kids, but I know I'll miss out on other things if I do," said Sartoris. "It's a tradeoff."
Sartoris & her husband
of 10 years travel for work & pleasure, are going back to school & spend time volunteering. Unlike their friends who have children, Sartoris & her husband also have the freedom to pick up new hobbies & activities & not feel guilty or time-strapped, she said.
"If you have children, you
have to consider your child," Sartoris said. "The idea that you can do it all & have it all is a real misconception."
The growing popularity of
an international social network for childless individuals & couples, called No Kidding, is further evidence of the increased
visibility of the "child-free." No Kidding now has 71 chapters & has a convention set for next month in Las Vegas.
What No Kidding provides is
the kind of social networking that many parents find in activities centered on their children, members say.
"PTA, school sports, carpooling.
For adults who have children, the children have a huge social network & are usually a starting point for meeting other
adults," says Mitch Greenberg, 41, who organizes events for a Maryland chapter of No Kidding.
The child-free social group
fills a social void for nonparents, he said, & helps replace friends who may have lost touch because parenting consumes
their time.
At some point, friends who
once had many things in common find themselves alienated from one another — even if reluctantly — when they choose different paths when it comes to childbearing. "Those
who we lose contact w/are usually the people who have children," says Greenberg, who has been married for 15 years.
"You no longer have things
in common & they're usually not available to do things," he said.
Along w/social isolation, some childless people claim that our family-centered culture can be unfair to them. Some childless workers complain of having to pick up the slack for working parents, or say they are more likely
to be expected to work longer hours or weekends.
What's Fair for the Child-Free?
Other complaints from nonparents
include watered-down group health insurance packages to compensate for others' young dependents, or the myriad benefits such
as unpaid leave, child tax credits or greater 401(k) contributions that are reserved for parents.
Of course, working parents
also have complaints about how they're treated in the workplace & Cain doesn't deny that government & corporate policies can punish both parents & nonparents for the choices they've made.
Parents & nonparents need
to start communicating w/one another about what is fair, Cain said. Working parents should be able to leave the job if their child is sick, Cain said, but so should childless workers
have opportunities to take personal time away for themselves as well.
A compromise could be for
companies to offer "personal hours" away from work instead of entire days, so workers could use their hours to fill their
personal or family needs w/out leaving for an entire day, Cain suggests.
But Cain, who has a 16-year-old
daughter, born when she was almost 40 years old, said her greatest hope is for people with & w/out children to understand & accept one another & their lifestyle choices.
"It could have been that I
didn't have a child, would it have made me a lesser being? I hope not," Cain said. "Each woman's life should be valued as important for the choices she makes."
Unmarried
women report feeling misunderstood in doctors’ offices
April 13,
2004
Regardless of sexual orientation, unmarried women ages 40 to 75 voiced reluctance to undergo routine cancer
screening tests - feeling out of place or misunderstood in common health care settings, according to the first wave of a new study.
Unmarried women said their feelings were based on everything from the wording used in pre-visit questionnaires to conversations with health care providers, according
to preliminary survey results from the 5 year Brown University Cancer Screening Project for Women.
For example, doctors’ intake forms didn't allow them to indicate any partner other than a husband &
- during the exam itself - their doctors usually didn't ask them about their intimate relationships.
‘Regardless of partnership preference, women in this age group were uncomfortable when their doctors assumed they didn't have a partner because they weren't married,’ said Dr. Melissa Clark, assistant
professor of community health & the project leader. ‘Women wanted a trusting relationship with at least one provider who knows about their life & is informed about the health issues related to their
sexual history & intimate relationships.’
The Cancer Screening Project for Women is one of the first studies to focus
on why unmarried women between the ages of 40 & 75 are less likely than married women to obtain regular screening tests
for breast, cervical & colorectal cancer. With the aging baby boomer population, the size of that population promises
to grow significantly in the coming years.
Some women think that they aren't at risk for certain types of cancer because they aren't in a sexual relationship with a man, said Clark.
Often they don't realize that there are a number of factors that must be considered in determining risk for cancer.
For example, a woman’s sexual history, among other factors, has a bearing on her chances
of getting cervical cancer & therefore, on whether she should be tested. While pap tests are recommended for women who
have at some point in their lives had a sexual relationship with a man, about 80% of women who partner with women fall into
that category.
The project’s initial results come from a series of focus groups
with 28 women - both lesbian & straight. The findings were published in the April 2004 issue of the journal Women &
Health.
In addition to feeling out of place in medical offices, focus group participants listed other barriers to obtaining cancer screening tests, including administrative
concerns such as lack of insurance, pain or discomfort associated with the tests & discomfort with their own body images.
The Cancer Screening Project for Women was designed to examine decisions surrounding
cancer screening & encompasses both urban & suburban health care settings, said Clark.
‘The results of our study can be used to inform a whole system of care,’ Clark said. ‘In order for
health care professionals to care for women in the best possible ways, it's critical for them to know what issues are important to women.’
Researchers plan to share the project’s findings with physicians
& other health care professionals such as mammography technicians & nurses & policy-makers.
The study is currently recruiting 600 unmarried women between the ages of 40 & 75 for the 2nd phase. The
Cancer Screening Project for Women is supported by an award from the National Cancer Institute.
Clark is collaborating on the study with other researchers affiliated with Brown’s Department of Community Health and
Center for Gerontology & Health Care Research.
Sources: Brown University;
Women & Health, April 2004.
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Fibromyalgia: New Insights Into a Misunderstood Ailment
Health experts recommend sleep, nutrition goals for sufferers
By Holly VanScoy
HealthDay Reporter
SATURDAY, Jan. 1 (HealthDay News) -- Fibromyalgia was once dismissed by many traditional medical practitioners as
a phantom illness.
But that view is changing rapidly. Not only is fibromyalgia accepted as a diagnosable illness, it's also a syndrome that researchers are finding more complicated as new information emerges.
As recently as a year ago, many physicians still associated some of fibromyalgia's symptoms with
emotional problems, but that's no longer the case.
A simple description of fibromyalgia is that it's a chronic syndrome characterized by widespread muscle pain & fatigue.
For still unknown reasons, people with fibromyalgia have increased sensitivity to pain that occurs
in areas called their "tender points." Common ones are the front of the knees, the elbows, the hip joints, the neck and spine.
People may also experience sleep disturbances, morning stiffness, irritable bowel syndrome, anxiety & other symptoms.
According to the American College of Rheumatology, fibromyalgia affects 3 million to 6 million
Americans, 80% to 90% of whom are women. The condition is most often diagnosed during middle age, but at least one of its
symptoms appears earlier in life.
But is there a psychological tie-in strong enough to differentiate fibromyalgia from other similar
diseases & conditions? Apparently not.
"Fibromyalgia patients are such a diverse group of patients, they can't all be the same," said
Dr. Thorsten Giesecke, a University of Michigan research fellow.
Giesecke & his colleagues evaluated 97 fibromyalgia patients, including 85 women & 12
men. The patients underwent a two-day series of tests, answering questions about their coping strategies & personality
traits - particularly their emotional well-being. They were also tested for sensitivity to pressure & pain.
"It's generally been thought that fibromyalgia patients who have higher distress have higher pain sensitivities," Giesecke said.
In other words, it was believed that those with fibromyalgia who were prone to emotional difficulties such as depression & anxiety were more likely to experience greater physical pain.
But his study didn't bear that out. In fact, patients in 1 of the 3 groups in the study who had
the highest pain levels had the lowest anxiety.
The term fibromyalgia comes from the Latin word for fibrous tissue (fibro) & the Greek ones
for muscle (myo) & pain (algia). Tender points are specific locations on the body - 18 points on the neck, shoulders,
back, hips & upper & lower extremities - where individuals with fibromyalgia feel pain in response to relatively slight
pressure.
The U.S. government's National Institute of Arthritis & Musculoskeletal & Skin Diseases says fibromyalgia patients
often experience combinations of many other chronic & frustrating symptoms, including:
- sleep disturbances,
- morning stiffness,
- headaches,
- irritable bowel syndrome,
- painful menstrual periods,
- numbness or tingling of the extremities,
- restless leg syndrome,
- temperature sensitivity,
- cognitive & memory problems, sometimes referred to as "fibro fog."
Latest research indicates that fibromyalgia is the result of internal biochemical
imbalances that cause physical symptoms such as pain, weakness & mental impairment. Because it's a syndrome - a collection
of signs & symptoms - rather than a disease, fibromyalgia can't be diagnosed by an invariable set of specific symptoms
or reproducible laboratory findings.
Even with the findings about relatively small psychological influence, practical
experience seems to indicate that stress may play a role. Roger H. Murphree, a Birmingham, Ala., chiropractor who specializes in treating patients with fibromyalgia
& chronic fatigue syndrome, said he has seen a link between stress & the intensity of fibromyalgia.
"Most of us live in a world of stress," Murphree said. "Something has to give & it's usually sleep. Meanwhile, we subsist on junk food, caffeine, alcohol &
prescription medications. Such a lifestyle isn't good for anyone. But for an unlucky few, the toll is severe."
Dr. Jacob Teitelbaum, whose practice in Annapolis, Md., led him to do research
into fibromyalgia & the closely related chronic fatigue syndrome, concluded that the body's endocrine system could hold the clue to treatment. It's a matter of how the
body's energy is marshaled, he said.
"Fibromyalgia is like the body blowing a fuse," he explained. "The hypothalamus serves as humans' internal fuse box. When the demands of living
build up, stress increases & the hypothalamus shuts down. Because the circuit is overtaxed & the fuse is blown, the body simply can't
generate enough energy."
"That causes muscles to cease functioning in a shortened position, resulting in pain all over the
body & a general feeling of fatigue or weariness," Teitelbaum said.
Murphree's experience with hundreds of patients confirms Teitelbaum's analogy. Most, he said,
are either "Type A" perfectionists or "Type B" caregivers.
"Type A fibromyalgia patients work & work & work until they burn out," said Murphree. "Type
B patients give & give & give - nurturing their spouses, children, family & friends - until they break down. Anyone
whose lifestyle includes very little downtime is at risk."
Teitelbaum recommends a 4-pronged approach to repair the "blown fuse" & turn the body's current
back on:
- Restoration of sleep -- at a minimum, 8 to 9 hours every night, using appropriate medications, as needed;
- Restoration of a normal hormone balance, including thyroid, adrenal & reproductive hormones;
- Appropriate treatment for infections that may be present as a consequence of the body's depleted immune function;
- Nutritional support, particularly with B complex vitamins, magnesium, zinc & malic acid.
Teitelbaum uses the acronym SHIN to summarize his treatment regimen. "S is for sleep, H
for hormone balance, I for infection control & N for nutrition," he explained. "The important thing is that all 4 should be implemented in concert with one another for maximum therapeutic effect."
More information
The
National Institute of Arthritis & Musculoskeletal & Skin Diseases (www.niams.nih.gov ) offers more information on
fibromyalgia.
Anxiety: The Most Misunderstood Element in End-of-Life Care
Source
December 19, 2003
In
her second report, Laura M Schmidt discusses the deep anxiety that commonly occurs in people confronted by their impending mortality. Laura, who is a writer & a thanatologist, has
volunteered for several years as a reporter & editor for ABCD (Americans for Better Care of
the Dying). She has agreed to report her personal experiences with hospice & end-of-life health professionals,
to help us learn from her encounters & experiences. Robert Griffith, Editor.
The biggest mistake I made when I learned I had pancreatic cancer was to run out of the doctor's
office. I was so overwhelmed with my diagnosis & (more importantly) my prognosis that I felt I had to get away from it. But by doing so, I walked into the biggest void in the end-of-life
field - anxiety.
That first night, Joe & I lay in bed, staring at the ceiling, all night long. We were too
upset to sleep & couldn't find a way to channel our energies. By 2 am I had already decided to call my internist, Dr.
Meyer & demand sleeping pills & Xanax®, a strong anti-anxiety drug. I desperately needed help!
For the dying person, anxiety comes from not only facing mortality & death, but it can also come from a variety of other, less profound, daily events.
Being prepared for chemotherapy & then having it cancelled at the last minute because the blood work isn't good enough.
Or not being told about a side effect of a drug until it happens. "We didn't want to alarm you,"
one nurse told me, "but it's very common for patients on your pancreatic cancer treatment regimen to become dehydrated." She
told me this after I had passed out at home on a Saturday night & my husband Joe was in a panic.
Yet, despite its commonality, anxiety in the dying person is rarely talked about or, even worse, understood. This came to light when I went to Georgetown's Lombardi Cancer Center for a second opinion. A very nice resident came in to do the initial intake assessment & after completing the physical & neurological
exam, he asked me a series of questions.
"Are you in any pain?" "How is your eating?" "How bad is your depression?" Answers in hand, he said he was off to report his findings to the doctor. I stopped him.
"You asked about my depression but didn't ask about my anxiety. Why?" "They're the same thing so I didn't want to ask a question twice," he said.
Depression & anxiety are NOT the same thing!
In fact, in many ways, they're totally opposite. While depression is widely defined & treated, anxiety is often mislabeled or ignored. The general definition of anxiety is "a universal & adaptive response to a threat," & mental health experts consider the onset of anxiety during a physical illness to be normal & short-lived.
However, when applied to the psychological
needs of individuals who are dying, this sense of anxiety is heightened beyond accepted expectations & deserves a careful examination.
Depression Versus Anxiety
I am terrified of flying. Even though I'm the daughter of an airline captain, I can't get comfortable sitting in a heavy box 35,000 feet above ground. One of the last times I flew was in 1972 when my mother & I, aged 22,
were going from Madrid to London. As soon as I saw the plane, I "knew" it was going to crash. My mother, who was used to my
behavior, took me to the airport bar where I had several glasses of wine to calm down.
By the time we were ready to board, I was beyond my alcohol limit yet my mind was amazing clear . . . & I was still terrified! It seemed as though no amount of alcohol could take away my fear. I even drew blood from my mother's arm when we hit a bad air pocket. It was only when the plane landed that my anxiety stopped . . . & the effects of the alcohol hit!
The point of this story is that anxiety supercedes every other emotion & feeling inside a person. This fear & stress, linked to each individual's survival instinct, is strong enough to prevent even chemical substances from being metabolized
normally. Only when the source of my fear was gone did the anxiety stop.
Anxiety would have done anything to avoid the source of my fear. Depression, on the other hand, would have calmly led me on the plane in the hopes that it would crash to end my misery.
When a diagnosis of terminal illness is presented to a patient, there isn't enough time initially
to become depressed. There is the overload of information as well as many doctor visits & tests which prevent the person from fully absorbing
what is going on.
Instead, anxiety may be the first emotion felt & the one that dominates the individual's mental well-being. According to the American Journal of Nursing,
the prevalence of anxiety among people with cancer or AIDS has been reported as high as 39%, compared to 25% who experience depression.1
The standard rules of health care must be
adapted to the
needs of the terminally ill. While anxiety & panic attacks are manifestations of psychological issues in the healthy person, this same diagnosis doesn't apply to the terminally ill
person.
Rather than being psychiatric in nature, anxiety is part of the individual's profound biological, emotional, psychological & spiritual makeup that must be resolved in order to have a "good" death. Unlike everyday events, which may cause
a person to experience panic, there's no escaping the shadow of death once a diagnosis has been made. Whether apparent or not, death is always on the
terminally ill patient's mind.
Depression evolves over a period of time; however, it only takes one second to become anxious. Even in shock & denial, the patient may exhibit physical symptoms, such as feelings of terror, rapid heartbeat, dizziness, muscle tension, or shaking in addition to panic attacks.
After a period of time, this anxiety leads to clinical depression, which is characteristic in end-of-life care.
For many patients who are imminently facing death, anxiety, not depression, is the greater concern because it can be related to unrelieved pain as well as emotional factors, such as fear & family members' reactions. As the disease progresses, these factors become more prominent. This is why some people
may become nervous, agitated & can't sleep in their final days.
Physicians can play a critical role in alleviating the stress of the patient's anxiety. Medications, such as Ativan® & Xanax®, should be made available to any dying person from
the moment of diagnosis so that the person is better equipped to deal with the formidable & frightening challenges to come. They should be viewed as "pain medications" for the soul.
In addition, patients may benefit from alternative methods, such as meditation or deep breathing,
counseling or, as cited in the Handbook for Mortals, by "channeling worries into productive endeavors."2
Laura Schmidt died peacefully,
at home, on February 25, 2004. She was being cared for by her husband, Joe, who plans to continue with the book that Laura
started to write. We shall try to bring you further extracts about her experiences during her final months. In the meantime,
visit ABCD (Americans for Better Care of the Dying) at http://www.abcd-caring.org/ to learn more about how you can help improve circumstances for people faced with a terminal illness.
Source
Footnotes
1. Managing psychological conditions in palliative care. JA. Paice,
American Journal of Nursing, 2002, pp. 102--137
2. Lynn, J. & Harrold, J. (1999). Handbook for Mortals. Guidance
for People Facing Serious Illness. New York: Oxford University Press, p. 91
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