According to Roni Caryn Rabin of the Times, the report, published by members of the American Psychiatric Association and the American College of Obstetricians and Gynecologists, recommended that doctors try talk therapy first if a woman's depression is mild or moderate. But it also said that the risks of antidepressant use and shock therapy on the developing fetus are low. Dr. Kimberly Yonkers, the lead author of the report, says,

There's not a one-size-fits-all answer. You can't say, ‘Stop medication for all women because it's harmful,' and you can't put all women on medication either.

Most pregnant women can probably agree that there is not a one-size-fits-all answer to their depression (for proof, check out the Times commenter who says she cured her PPD by drying and eating the placenta). But beyond that, the report may not give them much guidance. The authors still caution that because of the lack of randomized clinical trials on pregnant women, research on drug side effect is limited. And four of the report's nine authors had some connection to drug companies, casting all their drug recommendations into a certain amount of doubt.

Paxil, Celexa, and Zoloftall seem to increase the risk that a baby will be born with a hole in the heart. The holes often close on their own, and the risk of the defect is less than 1%, but it increases if the mother took more than one SSRI. SSRIs can also raise the risk of persistent pulmonary hypertension, a condition that impedes blood flow to the baby's lungs, but the risk of this is also low, about 1.2%. Perhaps the greatest risk is that of drug withdrawal, experienced by 15 to 30% of babies born to moms who took SSRIs late in pregnancy. This can cause irritability, hypoglycemia, and even seizures in babies, but usually gets better within two weeks. Untreated depression, of course, has its own risks. In addition to the dangers to the mother, it may contribute to premature birth, growth changes, or irritability in babies.

Not all clinicians even agree with the report's relatively mild recommendations. Dr. Shari Lusskin says,

By the time I get to hear about somebody's perinatal depression, it's usually worse than what can be treated with psychotherapy alone, because women go out of their way not to complain; they don't want to be put on medication, and they feel guilty. We should use a low threshold for treating women aggressively.

And though the report emphasizes the relatively small risk of drug side effects, many women aren't reassured. One commenter on the Times Well Blog, who suffers from bipolar disorder, wrote,

I've been stable for a long time, but going off all my medication might change that. A high-risk perinatal physician recommended that I stay on everything, because depression and manic psychosis may be harmful to the baby. But my psychiatrist recommended ceasing all medication for at least the first trimester, which is the phase where the developing embryo is most sensitive to mutagens. Her recommendation is that I should go off everything and then, if I have a problem, I should use electroshock therapy. I have decided that this is the right path to take. But I'm still putting it off.

Rabin interviews Sherean Malekzadeh Allen, who says, "Every single thing you put in your body when you're pregnant, you wonder, ‘Oh, my God, am I growing my baby an extra finger?' I was worried that I would hurt the baby if I took the pills, and I was worried I would hurt the baby if I didn't." She was so anxious about hurting her baby with her medication that, "I would wait six or seven hours before taking the pill, and just work myself up into more of a state." Ultimately, her son was born healthy.

Given the low risk of serious birth defects from antidepressants, Allen's story — in which the biggest side effect is maternal guilt — is probably the most common. The APA/ACOG report may have its problems, but at least it doesn't issue any blanket pronouncement that might add to this guilt. It may not be a very useful guideline, but it's true that depression, whether during pregnancy or not, should be evaluated on a case-by-case basis, and that what works for some sufferers won't always help others. For those pregnant women who respond well to talk therapy, the choice seems clear. But those who need medication have to balance the risks to their babies with the benefits of having a happy, healthy mother. Like so many aspects of parenting, this balance is individual, and the report deserves praise for acknowledging that.

Image via New York Times.

Depression Is A Dilemma For Women In Pregnancy [NYT]
Coping With Depression During Pregnancy [NYT Well Blog]

A previous estimate had put the prevalence of autism spectrum disorders (including Asperger's, which affects the young artist pictured above) at one in 150, but a new telephone survey and a more in-depth CDC estimate indicate the disorders are more common. Some of the rise may be due to improved detection, but Dr. Thomas Insel, director of the National Institute of Mental Health, says, "The concern here is that buried in these numbers is a true increase. We're going to have to think very hard about what we're going to do for the 1 in 100."

Others are more critical of the study's findings. The telephone survey in particular, which found an autism rate of 1 in every 91 children, has drawn fire. Researchers asked parents two questions: whether they had ever been told by a doctor that their child had an autism spectrum disorder, and whether the child currently had such a disorder. If they answered yes to both, the child was counted among those suffering from an autism spectrum disorders. But autism researcher Irva Hertz-Picciotto says the explanation of the disorder is given to parents was insufficient, and notes that the second question didn't actually ask about a doctor's diagnosis.

Also, 40% of parents who answered yes to the first question said no to the second, which is odd because autism spectrum disorders are considered incurable. Researchers think this means some children were initially misdiagnosed. This calls the whole study into question a bit, as it underlines how difficult autism spectrum disorders are to diagnose at all. Dr. Susan E. Levy, a member of the American Academy of Pediatrics subcommittee on autism, says, "With diabetes you can get a blood test. As of yet, there's no consistent biologic marker we can use to make the diagnosis of autism."

A genetic test for autism may be on the horizon. Until then, autism research and diagnosis will likely remain controversial. The CDC survey, whose full results have not been released yet, found a prevalence of about one in a hundred by analyzing children's health and education records — when it is fully made public, it may gain more acceptance than the telephone survey. But as long as a diagnosis is made based on somewhat subjective behavioral symptoms, scientists and parents will probably always disagree on how many children have autism, and how severe the problem is. It's interesting to note that half the parents of autistic children in the telephone survey believed their children's disorder was mild.

The new studies do add some evidence, however, to support the notion that the percentage of autistic children is rising. Unscientific yet popular theories about the dangers of vaccination have somewhat clouded a real effort to find out why this might be. If autism really is growing more prevalent, we need to figure out if any environmental factors are contributing to this growth. And be need to me sure our society is equipped to serve the needs of a growing number of autistic children and adults. Dr. Insel says the new studies raise "a lot of questions about how we are preparing in terms of housing, employment, social support — all the issues that many of these people are going to need. It also raises questions about how well we're prepared in the educational system to provide for the special needs of many of these kids." The educational system in America right now is neither very flexible nor very hospitable to children who fall outside a certain behavioral norm. This should change anyway — perhaps these new studies will provide some motivation.

Studies Show 1 In 100 Kids Have Autism [AP, via CBS]
Study: More Cases Of Autism In U.S. Kids Than Previously Realized [CNN]

According to a New York Times Magazine article by Sara Corbett, the psychoanalyst Jung "got lost in the soup of his own psyche" when he was 38. He said he was "menaced by a psychosis" and that visions were coming at him in an "incessant stream." "In order to grasp the fantasies which were stirring in me ‘underground,'" he wrote, "I knew that I had to let myself plummet down into them." His method of "plummeting" was to write these fantasies down in what is now called his Red Book, a volume full of cramped text and intricate paintings that his family has guarded closely until recently. Now it has been translated into English, and will be published in October.

For Jungians, says translator Sonu Shamdasani, the publication will be a huge milestone. But, Corbett asks, "What about the rest of us?" It's a good question. Corbett notes that Jung has come under fire for anti-Semitic and paternalistic ideas, and his brand of analysis — which takes about five years and focuses on "self-discovery and wholeness" rather than diagnosis and treatment — isn't exactly in vogue in the HMO age. Some people champion analysis as an antidote to supposedly cold, results-based treatments like SSRIs and cognitive behavioral therapy (Lisa Appignanesi, author of Mad, Bad, & Sad, appears to be a qualified supporter of analysis). But analyst Stephen Martin likens Jungianism to a religion, and it can seem like a pretty hierarchical one, in which you bring your psyche to an analyst and he tells you how to interpret it.

I once had a therapist who followed Jungian principles, and while I learned some interesting things from him, I definitely felt like he was telling me what to think about my brain. I got more and more weirded out by the secret violent impulses he claimed I had, and by his focus on my dreams — a big part of Jungianism. The last straw was when he told me not to tell anyone else about any dreams before I told him. I went back to cognitive-behavioral therapy, where at least I felt like I was in charge.

But there's more to Jung than what I experienced. Corbett writes,

The central premise of [the Red Book] was that Jung had become disillusioned with scientific rationalism - what he called "the spirit of the times" - and over the course of many quixotic encounters with his own soul and with other inner figures, he comes to know and appreciate "the spirit of the depths," a field that makes room for magic, coincidence and the mythological metaphors delivered by dreams.

It's true that cognitive therapy, with its emphasis on homework and tasks, can sometimes seem to deny the complexities of the brain. And sometimes distorted "cognitions" can be valuable in ways that a traditional therapeutic setting doesn't really allow for. I still haven't found a way to reconcile the fact that contemporary psychotherapy helps me and so many other people with the fact that it sometimes seems to oversimplify human life, to divide everything into healthy and unhealthy and banish certain interesting, if painful, thoughts. I'm not sure what "making room for magic, coincidence and the mythological metaphors delivered by dreams" would look like, and frankly I tend to regard dream analysis — especially when it claims to tap into a "collective unconscious" — as bullshit. But I do think that knowing and appreciating your personal "depths," even if they are unhealthy, might be better than denying them. In the Red Book, says Shamdasani, "The basic message he's sending is ‘Value your inner life.'" It's a simple message, but one that might do a lot of good.

The Holy Grail Of The Unconscious [NYT]

Roan says people with borderline personality disorder (BPD) "make a mess of their relationships — and no wonder, given the hallmark symptoms: mood instability, fear of abandonment, impulsive behavior, anger and suicidal or self-injurious acts. People with the disorder may misperceive the actions — even the facial expressions — of others." Borderline patients frequently also struggle with other mental illnesses or substance abuse. Psychologist Marsha Linehan, an expert on the disorder, describes it thus: "You can't regulate your emotions despite your best efforts."

Roan writes, "the composite of an angry, unstable, clingy, substance abuser is not a pretty one, and people with the disorder suffer greatly because they drive away even the people who love them most." They may also suffer stigma from the very people who are supposed to help them. One writer says some therapists use a diagnosis of BPD "to express hatred of patients," and psychiatrist Richard G. Hersh tells Roan, "borderline personality disorder is considered a pejorative term." A test for BPD, the Diagnostic Interview for Borderlines, describes the disorder as being characterized by "sexual deviance," "manipulativeness," "demandingness," and "entitlement." Therapists who are looking for these qualities in their patients may well develop a negative attitude toward them — especially if patients prove difficult to treat.

Dr. Josepha A. Cheong of the American Psychiatric Association says media portrayals of borderline personality disorder — like Glenn Close's bunny-boiler in Fatal Attraction — are often inaccurate. She says a better example is Jenny from Forrest Gump, "a somewhat sympathetic but self-destructive, dysfunctional woman who wanted a normal life but couldn't achieve it." But maybe an even better example would have been a man.

Although Roan says men and women suffer borderline personality disorder in equal numbers, many still consider it to be a woman's disease. This may be in part due to media influence — the main character in Girl, Interrupted is also diagnosed with BPD — or because men are more likely to be diagnosed with other problems. Whatever the cause, the image of the "clingy" patient who can't regulate emotions tends to be the image of a woman.

But clinicians may now be focusing less on stereotypes, and more on what patients can do. BPD was front-and-center at this year's meeting of the American Psychiatric Association, and today's therapies offer hope, not judgment. Roan mentions Linehan's dialectical behavior therapy, which encourages therapists "to balance acceptance and change." In addition to teaching strategies for forming healthier relationships, therapists also "highlight for clients when their thoughts, feelings, and behaviors were 'perfectly normal,' helping clients discover that they had sound judgment and that they were capable of learning how and when to trust themselves." Dialectical behavior encourages doctors to see borderline patients as people in pain who also have the capability to lead normal lives. This image may not be as sensational as a bunny-boiler, but it's a lot more helpful.

Borderline Personality Disorder Grows As Healthcare Concern [LA Times]
Reducing Severe Episodes Of BPD [LA Times]
What Is Borderline Personality Disorder? [LA Times]

Called "prolonged exposure" therapy, it requires patients to imagine reliving their most terrifying moments — the rapes, muggings, combat scenarios, or accidents that sent them to therapy in the first place. Long used for OCD, phobias, and anxiety, exposure therapy hasn't been popular for post-traumatic stress disorder because, according to Kamps, "PTSD sufferers may be in extremis, crippled by their fear and sometimes violent." But therapist and anxiety expert Edna Foa says "that people need to viscerally learn that they can withstand what they think they can't." When they repeat their traumatic memories over and over, they can "become, if not bored by them, then at least less distressed."

Kamps quotes Kim McGillivray, who received the therapy to help her deal with dramatic memories of her abusive ex-husband. She tells the story of seeing her ex-husband after a breakthrough in therapy. He was "wearing tiny jogging shorts and tube socks pulled up snug to his knees." McGillivray says,

I had that instant flash of recognition, but in the second flash, I just thought, Dork! I was sitting there in the car, laughing, going, ‘Oh my God. Whatever is happening is working, it's taking root.' I could finally see him as other people did-as just this nerd who didn't have the right athletic equipment-instead of as the monster he was to me. After years of being told I was utterly useless, it's like I've been given another shot. And that I'm able to say all this without weeping-to view things in my past without having to be totally rolled-is testament to the process. I'm back in the human race.

The science seems to back up her experience. A small survey of 127 women who underwent prolonged exposure therapy showed that, at an average of six years post-treatment, 80% had none of the symptoms of PTSD. Other studies have found that the therapy reduces PTSD symptoms by 70%. These findings are particularly encouraging in a field where confirmation of a technique's effectiveness is uncommon — Kamps reports that there is no hard data on how well traditional psychodynamic therapy works.

These concepts — "evidence," the very idea of something "working" — are fraught in the field of psychotherapy. I've had a therapist tell me my goal shouldn't be getting rid of my anxiety, but rather gaining better insight into myself, and I'm sure I'm not alone. And while insight is indeed valuable, patients do have the right to therapy that improve their ability to live their lives. And insofar as this improvement can be measured — obviously, it's not as simple as curing strep throat — it should be.

Kamps talks to psychologist Patricia Resick, who suggests that our relatively safe modern-day lives have given us an "illusion of control" that contributes to PTSD and other mental illnesses. "When something bad happens," Resick says, "people think they must have done something wrong to deserve it." But in reality, there are plenty of things in modern life that we don't control — from our own health to, say, healthcare reform — and people are smart enough to know that. By giving them an evidence-based tool they can use, exposure therapy may give PTSD sufferers a way to control, if not their lives, at least their thoughts. Being able to do this is a big step along the way to being mentally well — and to feeling empowered again after something or someone has taken that power away.

Prolonged Exposure Therapy [Elle]

In his appearance (the teaser for which appears above), Pantoliano mentions that he takes antidepressants, and argues for the less controversial causes of mental health parity and frank discussion of mental illness. He's founded a nonprofit organization "based on accepting, encouraging people to admit to their disease — to seek treatment and become even greater members of society." But some members of the Mad Pride movement prefer to forgo treatment — at least, the conventional psychiatric variety.

ABC's Ia Robinson and Astrid Rodrigues talked to musician Madigan Shive, who was diagnosed with bipolar disorder but now prefers not to label her condition. Though she has delusions and "extreme state[s] of consciousness," Shive doesn't take medication or go to psychotherapy. Instead, she relies on her own "mad map" of triggers and coping strategies, and a network of friends who will take her to a hotel room, instead of a hospital, when her symptoms become severe. She says, "Please don't change this thing in me that creates this music and keeps me alive. ... I need my madness."

Shive says she knows people who take psychiatric medication "and use it smashingly well and I support all that." Similarly, David Oaks, leader of Mad Pride group MindFreedom International, says his organization isn't against drugs, but only against forced drugging of people who would rather manage their illness in other ways. One of MindFreedom International's FAQ pages says, "one of the main human rights violations in the mental health system today, is the way the psychiatric drug approach dominates, squeezing out alternatives and spreading dis-information."

Writer and psychiatry lecturer Charles Barber might agree, though he comes at the problem from a different direction. In a Salon article, Barber advances the recently popular argument that the rise in antidepressant use in America can be blamed on pharmaceutical marketing. Of TV ads for antidepressants, he says,

Often it is hard to tell exactly what condition the drugs are treating. The taglines of the drugs are often vague - for drugs for depression, the slogans might speak broadly but inspirationally about change and hope and getting back to one's true self. (Now that I think of it, these meta-messages are not unlike those of the Obama campaign.) The drugs thus appear to be defined less as mediators of specific medical conditions than as ways to enhance one's lifestyle and quality of life. And this is good for business: It turns out that the market base of people who are interested in enhancing their lifestyle is far greater than of those who suffer from major depression and other serious and debilitating mental illnesses.

Barber doesn't really address the problems with the health insurance industry that cause many people to take medication when more expensive therapy — or a combination of meds and therapy — might be more effective. Instead, he's more interested in branding those who take antidepressants as greedy consumers intent on "enhancing their lifestyle." And is he implying that the Obama campaign, too, was trying to sell us something we don't need?

It's become popular to argue that lots of people are on antidepressants for frivolous reasons, for what Barber calls "the blues, or financial, career or relationship problems, all of those things that we used to regard as life problems, and not medical or diagnosable ones." Most people who make this argument blame the pharmaceutical industry, but some, like Barber, seem to reserve a bit of blame for patients as well. It's undeniable that more people are taking antidepressants than ever before, and it's certainly possible that some could benefit more from other treatments. But who are these vaunted pill-poppers who don't "really need" their Prozac? Whose problems are too minor for drugs, better suited instead to finger-wagging and a course in biting the bullet? Would Barber be willing to point the finger at someone who's lost a job, a marriage, a child, and say, this form of relief should not be available to you?

A more compassionate approach would be to examine psychiatric drugs from a patient's point of view. Are they being pushed on patients who don't want them? Do antidepressants lessen patients' self-reported feelings of sorrow over what Barber calls "life problems"? Are there other treatments or practices that might help them more? In many cases, the answer to this last question is yes, and when that's the case, insurance should cover these more effective practices. But we're not going to get the answers to any of these questions if we infantilize patients, assuming they're all reaching for something they saw on TV as an easy way out of their troubles.

There are plenty of problems with the Mad Pride movement — for one thing, untreated mental illness can make people hurt themselves or others. Robinson and Rodrigues mention John Hinckley and Virginia Tech shooter Seung-Hui Cho as people whose violence may have stemmed from insanity. Oaks says, "The vast majority of people with psychiatric diagnoses [...] — we're law-abiding, we're peaceful," and this is no doubt true, but he doesn't offer a solution for people who are so violent or suicidal that they can't make decisions about their own treatment. At least, though, Oaks and his fellow Mad Pride activists argue for more autonomy for those who are suffering. In arguing against the pressures of pharmaceutical companies, Barber is actually exercising his own kind of pressure.

At the end of his piece, Barber changes direction, acknowledging, "I can claim confidently that there is, right now, a high-water mark of worry and suffering on numerous fronts - economic, of course, but also social, with our ever-increasing isolation and Internet-driven loss of human connection and the ongoing trauma of wars and crises that just don't seem to end." In some ways, he recognizes, this is a difficult time to be alive. Perhaps it's not so shocking that many people turn to medication for relief — and that others find more relief in refusing such medication. And while both approaches have drawbacks, perhaps we should be a little slower to judge them.

'Mad Pride' Activists Say They're Unique, Not Sick [ABC]
Are We Really So Miserable? [Salon]
MindFreedom International [Official Site]
Teaser - Joey Pants on ABC Primetime - Tuesday, Aug. 25 at 10pm [YouTube]

Allen, who hadn't had a Pap smear in 10 years despite the urging of her regular doctor, scheduled an exam following the death of British reality TV star Jade Goody from cervical cancer. Although she finds Pap smears traumatic, when meeting her gynecologist and nurse for the first time, she failed to reveal her mental illness or that she finds the experience trauma-inducing.

The nurse was a perfectly kind and decent woman. The doctor she went off, mid-process, to fetch was probably more or less human too – by that point my judgment was somewhat impaired – but neither appeared to have even the most basic comprehension of my position.

"Why are you so upset?" asked the doctor, laughing, presumably in some misguided attempt to lighten the atmosphere. Lying naked from the waist down on a couch with my legs in the air didn't strike me as the most appropriate time to discuss it. "None of us like it," she told me, smiling. "But it's not as bad as going to the dentist." By the time I left, I was in such a state I cannot even remember going home.

Well, to be frank, of course he lacked comprehension of her position — because she didn't tell him anything about what her position was. He and his nurse were facing a person who, for very legitimate but undisclosed reasons, was having a severe emotional reaction to a routine medical exam.

Allen says that a short conversation before or after the exam might have helped — although, by her own admission, she was so upset by the end of it that she doesn't remember getting home. And, yes, some doctors can lack bedside manners, or patients can be stacked too close together to allow for conversation, or the patient's own demeanor might lead them to believe that she doesn't wish to engage in conversation. But, at the end of the day, when you're visiting a doctor for the first time, or have relevant medical information of which they are unaware, information that wouldn't come up on a checklist screening (like mental illness or a history of assault) but can affect the exam or its results, the full responsibility doesn't lie with the gynecologist. If you wouldn't go to your therapist and keep quiet about it, you shouldn't keep it from your regular doctor or your gynecologist, either.

I'm not going to pretend it's fun to tell a relative stranger, health professional or not, that you've been raped or have a history of mental illness that predisposes you to find certain medical procedures or examinations traumatic. It's not. I never thought to inform my doctors until graduate school, actually, when, due to switch in my birth control prescription, I ended up with a yeast and a bacterial infection (nasty, I know). The doctor at student health services was, let's say, far from experienced in the art of giving a pelvic exam and, in an effort to preserve the sanctity of his specimens, shoved the speculum in me without any lubrication. When the examination was over, I sat up, looked him in the eye and told him that before he shoved a speculum in another woman without lubrication and told her to relax, he'd damn well better think to ask if she had a history of sexual assault.

Recently, when I went for my 6-month follow-up exam to my rape kit (and my annual Pap smear), I explained to my doctor — who has always been extremely efficient but with whom I lacked a certain rapport — that I'd been sexually assaulted since my last visit. And suddenly, the experience of the exam changed. She was kind, thoughtful, and empathetic — and she spent more time talking me through the (very gentle) pelvic exam than she had in the past. I imagine that most medical professionals - particularly gynecologists - would do the same if they could, if only given the right information.

Why I'm Never Going To Have Another Smear Test [The Guardian]

Specifically, author Mark S. Micale says "the specter of male physicians gazing with passionate intensity on other adult men in intimate emotional distress suggested an unacceptable homoerotic intimacy." Reviewer Sherwin Nuland of The New Republic writes,

"Sustaining patriarchy, however," Micale makes clear, "required both idealizing the virtues and denying the vulnerabilities of hegemonic bourgeois masculinity." As a result, the homogeneously male medical community leaned toward restricting their diagnoses of nervous disabilities almost exclusively to female patients, thus contributing to a model of masculine human nature which, although fragile and ultimately shown to be untenable, operated successfully over a span of more than two centuries.

Translation: the patriarchy sucks for guys too, especially if you're sick.

Macho Misery [The New Republic]

Conventional thinking says that Asperger's and other autism spectrum disorders are four to sixteen times as common in boys as girls. But Gould thinks a more likely ratio is 2.5 boys to every girl. She says the underdiagnosis is caused by "a stereotyped view of what Asperger's is, which is based entirely on how boys present with the condition." Tony Attwood, author of The Complete Guide to Asperger's Syndrome, agrees, saying:

Boys tend to externalise their problems, while girls learn that, if they're good, their differences will not be noticed. Boys go into attack mode when frustrated, while girls suffer in silence and become passive-aggressive. Girls learn to appease and apologise. They learn to observe people from a distance and imitate them. It is only if you look closely and ask the right questions, you see the terror in their eyes and see that their reactions are a learnt script.

Getting clinicians to see this "terror" is especially important, because, according to Attwood, "undiagnosed Asperger's can create devastatingly low self-esteem in girls." He even says that "in my experience, up to 20% of female anorexics have undiagnosed Asperger's."

Doctors Are 'Failing To Spot Asperger's In Girls' [The Guardian]

According to the study authors, "mothers who were emotionally unstable, anxious, angry, sad, had poor self-confidence or a negative view of the world" were more likely to give up in difficult situations and to feel less in control of their kids. Psychologist Eivind Ystrøm says,

I think that mothers compensate for this either by trying to force healthy food into their child or hold the sweet-bag strings extra tightly. Paradoxically, they try to balance poor control by actually using more control. With force and restrictions they increase desire which quickly results in resistance in the form of tantrums which these mothers are also bad at resisting. Also, earlier studies have shown that controlling behaviour among parents is linked with a more sugar-rich diet among children.

This sounds a little harsh on Mom to us, but Ystrøm does note the need for research into how dads' moods affect kids' diets, and into how to both relieve stress and improve kids' diets. The study authors don't mention it, but we wonder if unhappy parents also get some vicarious pleasure out of feeding their kids sweet or fatty foods, especially if they deny themselves those foods. Giving kids tasty food can also make parents feel good about themselves, even if the treats they serve aren't all that healthy. We echo Ystrøm's call for ways to reduce maternal stress — and we'd also like to see some research into how comfort food can affect the server as well as the eater.

Maternal Personality Affects Child's Eating Habits [ScienceDaily]

Psychologists at the University of Ulster and De Monfort University questioned 571 people aged 17 to 25 who had only sisters or brothers, both, or were only children, reports The Daily Mail. Researchers found that subjects who grew up with at least one sister were generally happier, more ambitious, and more emotionally balanced than those who only had brothers. [Aww, I am forwarding this to my sister right now. — Dodai]

"Our explanation for it is that the presence of girls opens up channels of communication and it becomes a much more expressive situation that's positive," said University of Ulster researcher Tony Cassidy, who co-authored the study. "Emotional expression is fundamental to good psychological health and having sisters promotes this in families."

Researchers also found that people with sisters were more successful in their careers, as subjects with sisters were more likely to strive to reach their goals. "It certainly seems there is something about the family situation with the number of girls in it that leads to more encouragement to achieve and be independent," said Cassidy.

Women benefited the most from having sisters in families where the parents were still married, but in divorced families both men and women benefited equally from having sisters. "It seems [sisters'] natural inclination was to express themselves, talk about the separation and encourage other family members to do so as well. It seems to help keep family relationships going," said co-author Liz Wright, research fellow at De Montfort, according to The Times of London. "There was markedly less distress in broken homes with a sister."

Brothers had a less positive effect, and men who grew up with lots of brothers scored the lowest for emotional health. "The more natural trend for boys is not to talk about things," said Cassidy in The Daily Mail. "When there are a number of boys together, it is almost like a conspiracy of silence no to talk, whereas a girl in that context breaks it down."

As for only children, their scores fell between those with only sisters and those with only brothers. "It seems many only children had built up significant social support outside the home by the time they reached their late teens which helped them in a crisis and in other areas of life," said Wright.

Why Having A Sister Makes You Happier And Helps Families Bond [The Daily Mail]
Growing Up With A Sister Makes People More Balanced [The Times Of London]

An estimated 2 million teens in America — or 6% — are depressed, and most don't receive treatment. A pediatrician can diagnose depression using a questionnaire, and the panel says such questionnaires should be used even for teens who don't exhibit obvious symptoms. "You will miss a lot if you only screen high-risk groups," said panel chairman Dr. Ned Calonge. Having a familiar doctor perform the screening might make it feel less stigmatizing for teens, and catching depression early can help prevent "persistent sadness, social isolation, school problems and even suicide." Sounds like a good idea. [NYT]

Suicide outbreaks are rare, but not unprecedented: the article references the rash of copycat suicides that followed the publication of Goethe's Sufferings of Young Werther, an outbreak of female suicides in Ancient Greece, and a more recent Japanese suicide cult. Immediately, the ever-sensitive British tabs (which ran headlines like "two more hangings rock death-cult town; two cousins from ‘suicide town' hang themselves within hours as death toll rises") speculated that the epidemic was fueled by a similar internet suicide ring, but those who knew the victims have denied it.

So, why? "Copycatting" is a natural response, to a degree, because not only does suicide create an atmosphere of grief and depression but, as the article puts it, it "lowers the threshold, making it easier and more permissible for the next. As one girl puts it, "I felt less scared knowing one of my friends had done it." And it seems like the media blitz has only spread the epidemic: after the tabs got wind of the phenomenon, there were four hangings in quick succession. It's well known that Britain generally is having increased problems with youth behavioral problems and there's a breakdown of communication between the generations. But why this one town? Well, as the author notes, it is a dreary place: a depressed former mining community with a dark and depressing aesthetic, that no one leaves, fostering "the boredom, demoralization, and anhedonia of being inextricably stuck in some backwater place. As one Bridgend girl told the Telegraph, 'Suicide is just what people do here because there is nothing else to do.'" It has been suggested that the entire sun-deprived region suffers from a kind of permanent Seasonal Affective Disorder that makes the residents more prone to depression, and this suceptible to copycat suicide. And at this point, it could actually be genetic:

As in many rural parts of Europe, families have been living in the same place for generations, which means that their cumulative coefficient of kinship is similar to what you'd expect between cousins. This suggests that traits like suicidality and depressiveness, and the low levels of serotonin in the brain they are associated with, could be more concentrated in certain regions. A study of the brains of suicide victims who were abused or neglected as children found epigenetic changes-that is, chemical alterations on the "outside" of DNA strands, which can be caused by environmental factors. So the effect of parenting-good, bad, or nonexistent-might have a lifelong impact by determining which genes get expressed and which get "switched off."

Exacerbating the problem, there is no culture of dealing with suicide or depression. Even the leader of the local young people's club, the one person who seems invested in the kids, says the younger generation "have lost their tough-mindedness... When we were growing up, you didn't kill yourself. You dealt with it. One guy who did and left two kids was always referred to as ‘that bastard.' It was a hard life in the coal towns, but a good one. There were accidents in the mines, and colliers died of dust." But of course, there were the mines: whatever the hardships and struggles, life took a more predictable path. The traditional hardscrabble life of a miner still probably provided far more structure than days of boredom and inactivity, especially with the taunting contrast of movies, TV and easy celebrity now omnipresent. It's a tragic story, and the article's a harrowing read, because one sees no end to the despair. What is particularly galling is the contrast of the media's sensationalism and the community's lack of concrete support: Neil, the club leader, mentions that the community center is flailing financially and that the government hasn't provided so much as a qualified counselor to the area. Yet, the media fascination continues, speculating, moralizing, sensationalizing, when it seems like this could be a perfect opportunity for analysis, study, solutions and prevention of further such outbreaks - for surely this will not be the last. Suicide epidemics seem more exciting when they're shrouded in mystery, perhaps, or associated with cults and svengalis. But the truth is that the epidemic seems like a natural and inevitable outgrowth of these kids' quotidian malaise. And if this is the only excitement and interest they have generated from anyone, ever, can people wonder that suicide is glamorized?

The Mystery Suicides Of Bridgend County [Vanity Fair]

Celebrities have the ability to reach an audience who ordinarily might not even think about (or recognize the legitimacy of) mental health concerns. While we’re not into celebrity worship here, we believe that people can use their popularity for good when they talk about mental health issues out loud and in public. The more people get talking about mental health, the more it reduces the stigmatization and misinformation about these issues.

Tara Parker-Pope of the New York Times agrees that celebrities have the power to bring attention to important issues. For instance: Michael Phelps has won Olympic medals, despite having ADHD as a kid. Carrie Fisher has bipolar disorder, yet is a funny, best-selling author. And career expert/blogger Penelope Trunk is also on board with this idea: "If you don't read about celebrities, you're missing a big learning moment," she writes. Trunk believes you can "use celebrity messes to gauge how you're doing in your own failures."

Has the exposure of stars' lives made them into examples? Made us not into voyeurs, but students? With every DUI bust, do we learn not to drink and drive? Every time we witness a celebrity crack under pressure, do we learn to ask for help? Is it possible that the public's current zest for schadenfreude is a secret, massive therapy session?

Celebrities And Mental Health [NY Times]
Make Better Decisions For Yourself By Watching Decisions Celebrities Make [Penelope Trunk's Brazen Careerist]
Related: Celebrity Psychings [Psych Central]

First, the stats: whereas suicides amongst white men 40-64 rose 2.7%, the corresponding female demographic experienced a 3.9% jump, with a particularly dramatic rise (57%) in the number of deaths by poisoning. Says one researcher, "Definitely these are not just little blips...We are looking at a big population change." No one quoted, however, advances a theory about the causes of the trend. "Are these people living alone, with no major responsibility or others to take care of, or are they people overwhelmed with all of the jobs and responsibilities they have? We need to find out more about the conditions under which these people are living." Well, yes, we do.

It's no secret that women suffer from far higher levels of depression than do men; the factors are both physiological and psychological and, as has been suggested on this site, women are probably just more aware of depression generally. But a precipitate rise like this suggests factors beyond the biological. Consider Dodai's recent post in which she commented on the finding that a depressing number of women feel their "life is over" at 44. Another British study, this one sponsored by Dove, reports that "negative attitudes by employers and society in general make women over the age of 45 feel unrecognized and unsupported," pervasive ageism prevents them from achieving goals and that those older women who do accomplish things are not recognized. In a society that worships youth, aging is not easy. Nor, one imagines, is empty-nesting, later-life career woes and relationship problems, health worries or financial struggle. And certainly these pressures have only increased.

While considering these issues, I decided to consult someone in this demographic: my 58-year-old mother, no stranger to this phenomenon. As I suspected, she had a lot to say. Her feeling is that it is not a coincidence that these women belong to the Boomer generation. "Because we were such a huge generation, and because, I think, our parents' generation had been through so much, we were pandered to in an unprecedented way," she says, "in advertising, society, everything. And we were all so defined by being young that we took an adversarial attitude towards age that has made things very hard as we grow older."

(She then went off on a tangent about women who are willing to "shoot poison into their faces" lest they fall into "one of the two acceptable modes of aging: cute or creepy.")

And women specifically? "Never before," said my mom, "were there such high expectations for women. My mother may have been disappointed with aspects of her life, but she did not feel like a failure. Whereas, we were the first who were encouraged to dream really big. We did, and a lot of us failed to realize those dreams. We felt we had far more riding on it than men, so the crisis in some ways is probably more painful."

I am sure that further studies will do far more to illuminate the root causes of these trends — socio-economic and otherwise. Whatever the findings, the solution is quite obviously better mental health care and perhaps a widening of demographic scope; ultimately, stopping something so tragically destructive is far more important, short-term, than the theory. But it is worth considering the pressures and advantages of this generation of women, unique in history and society; change, for good and bad, is very rough work.

Middle-Aged Women Drive Rise In U.S. Suicides [MSNBC]

Related: How Prejudice Holds Back Women Over 45 [Daily Express]

Earlier: Why Do Some Women Think That Life Is Over By Age 44?