Interesting item in Newsweek: Sharon Begley discusses new findings (discussed in Scientific American]that strive to determine if there's any evolutionary benefit to what we consider clinical depression, a subject much on the minds of certain brain researchers. The questions: is a little depression not just natural, but healthy? In scientific terms, is there some reason for the Black Dog? This implies a fundamentally different way of considering what's been termed a mental illness. Say the study's authors, "There is another possibility: that, in most instances, depression should not be thought of as a disorder at all. " Here's how Begley describes it:

Writing in the journal Psychological Review, postdoctoral fellow Paul Andrews of Virginia Commonwealth University and psychiatrist J. Anderson Thomson Jr. of the University of Virginia present research suggesting that depression is present in the species, and in individuals, for a purpose, and we're playing with fire if we try to eradicate it. In evolution-speak, depression is an "adaptation," they argue. That is, it evolved because it made individuals who experienced it fitter, under natural selection, than individuals who did not experience it. Andrews and Thomson-who is best known for research on the psychology of religious belief, and who has also studied whether antidepressants threaten love and fidelity-offer as evidence the presence of a molecule in the brain called the 5HT1A receptor. This serves as a docking port for the neurochemical serotonin, which the Prozac/Zoloft/Paxil class of antidepressants targets. Human brains are not the only ones with the 5HT1A receptor. Rats also have it.

And said receptor's important to recognizing and dealing with stress and threat, rather than leaving us (and rats) in a perpetual state of unwary bliss. "In other words, losing the receptor that promotes depression in response to stress is something evolution thought would be a very bad move. Ergo: depression is not something to be thrown out lightly." Indeed, it's suggested that depression can lead to analysis and solutions, focused thinking, and even "negative" depressive traits - such as self-isolation or loss of libido, ie the reason we take Paxil - that may serve an adaptive function.

There are some really interesting points in here: are we overmedicated? Probably - and a little sadness, as the author says, should not be the bogeyman it's become in our times. But clinical depression - either human or rat - is a dicier issue altogether. As these researchers would surely be the very first to point out, even if depression can be proven to have en evolutionary purpose, as we all know, what's good for us as humans isn't necessarily good for us as people. Then too, it seems pretty logical that plenty of modern stimuli - to say nothing of pharmaceuticals, diet, chemicals, environment - could have a hand in that depression that Mother Nature had absolutely nothing to do with. Then there's the other elephant in the room: depression can lead to suicide - which, in the small scheme, isn't helping anyone's progress. It's both fascinating and reassuring to know that there may be an evolutionary rationale for what can feel like an unfair genetic curse, and with any luck, if true, this will be of substantial use to researchers. But as it stands, I'm not canceling that Lexapro prescription any time soon.

Depression's Evolutionary Roots [Scientific American]

The Upside Of Feeling Down [Newsweek]
The Bright Side Of Being Blue [APA]

The ABC News story by Susan Donaldson James is a little frustrating. We find out that Vilar (in the video above, reading from an earlier book) has a troubled family history — she was born in Puerto Rico, where by 1974, 37% of women of childbearing age had been sterilized in an American-led experiment. Her mother had a hysterectomy with no hormone treatment at age 33, which led to depression, addiction, and eventually suicide. Two of her brothers were heroin addicts. As a teenage college student, she met her future husband, a 50-year-old professor who believed "having children killed sexual desire." Their marriage was troubled, and she engaged in self-mutilation and attempted suicide — but here's where things get confusing. James writes,

Vilar's pregnancies became compulsively self-destructive: After her 9th and 10th abortions, she "needed another self-injury to get the high."

"In the beginning I was taking pills and I'd skip a day or two or give up one month," she said. "I'd think I'll be better next time. But slowly, my days took on a balancing act and there was a specific high. I would get my period and be sad, then discover I was pregnant, being afraid, yet also so excited."

Vilar's description of what happened "after her 9th and 10th abortions" is disturbing, but what happened before then — how did she get to nine? Did the cycle of self-destruction actually began much earlier, was her husband uncooperative about birth control, did they decide to try for children and then back off? And, given that Vilar is obviously an extreme case, do these questions matter at all to the larger abortion debate?

Both James and Vilar are trying to make them matter. In the place where she might have explained to us what was going on between abortions one and nine, James instead gives us statistics about women who have multiple abortions. 10% of women who have one procedure, she says, will have three or more. She writes that "little is known about these women" but that for them, some research "might indicate mental problems." She also quotes Vilar, who says that women who have multiple abortions exhibit "recklessness."

But was Vilar really "reckless," any more than someone who self-harms by cutting is "clumsy?" Her 15 abortions seem like the product of depression and a bad relationship, not a cavalier use birth control — her contraceptive lapses became, as she says, intentional. That said, "little is known" about Vilar, because James doesn't give us her full history. She's too concerned — and, to be fair, Vilar is on board as well — with painting her as a type of "woman who has multiple abortions."

At first glance, Vilar seems like the perfect example for pro-lifers who think abortion rights encourage women to throw caution to the winds. But really, she's an example of how people who are desperate and depressed can do strange and disturbing things. Given that she saw abortion as a form of self-mutilation, it seems likely that she would have gotten dangerous back-alley procedures if she had to. And if for whatever reason abortion hadn't been available at all, she might well have turned to another method of "self-destruction."

Vilar says,

Women have a deep need for agency, for purpose and direction and society is not providing natural and healthy channels for creative action.

In school and on TV, every message I get is what I am doing as a mother or wife is wrong. I should be thinking about a profession and not mothering. Everyone is having babies, and yet they don't want to care for them.

Are many of the repeat abortions in part an embodiment of this mixed message? A lost, ambivalent attempt at an act of agency that cannot find its proper vessel?

I'm not sure that "many of the repeat abortions" can be explained in this way — or in any one way. But it would be interesting to see how a conflicted culture of motherhood influenced Vilar's particular form of "addiction" (a word she uses). Unfortunately, we don't really get that story.

Abortion Addict Confesses 15 Procedures In 16 Years [ABC]
Irene Vilar [Official Site]

Subtitled A History of Women and the Mind Doctors, Appignanesi's book aims to trace the relationship between women's "madness, badness, and sadness" and their treatment by (usually male) professionals from the late 18th century to the present day. The book does a good job of describing the connection early physicians saw between physical and mental ailments — the "moving womb" theory of hysteria, the fits of numbness and paralysis supposedly brought on by a frightening sight or memory. The "mind doctors" of the 18th and 19th centuries were of course wrong about the specifics of these connections (breast milk, for instance, does not travel into the brain and cause insanity), but it's interesting to note that they understood what we sometimes forget — that the mind and body can influence each other, for good and ill.

Unfortunately, this awareness often led to sexism. Appignanesi notes that doctors in the second half of the 19th century believed that problems with the female reproductive system caused "nervous afflictions," and that,

Throughout this period, doctors and scientists seemed determined to raise the existing division of labor in the middle class to a universal given, and to transform women's place in the domestic sphere into a biological inevitability from which deviation of any kind would bring breakdown, not only of the mind but of the species. Women were understood as being fashioned by evolution for the home and maternity, nervously fragile, intellectually inferior. Moving away from that lesser birthright, allowing energies to be drained by intellectual or imaginative exertion would lead to nervous collapse or to that capacious list of symptoms which most often went under the catch-all diagnosis of neurasthenia or its near-neighbour hysteria.

Prejudicial theory was often matched by brutal practice. Pelvic surgery and force-feeding were common treatments, and Appignanesi tells the story of one woman fed so violently in an asylum that all her teeth were broken. Especially gruesome was early 20th-century hospital superintendent Henry Cotton, who believed psychosis was caused by "chronic pus infections" and who "treated" sufferers not only with tooth removal but with surgery on the stomach, tonsils, uterus, and colon.

There's an interesting book to be written about how fads in mental treatment have harmed and helped women's bodies and minds over the past two centuries. Mad, Bad & Sad is not that book. Appignanesi offers overlong and sometimes jumbled case histories in lieu of any real tracking of trends. Instead of a full picture of how culture has shaped women's diagnosis and treatment, we get scattershot portraits of such ailments as hysteria, neurasthenia, eating disorders, and borderline personality disorder without a coherent explanation of what brought each of these conditions to the fore. It's clear that aspects of mental illness are culturally determined — there's a reason why the diagnosis and even the symptoms of hysteria were prevalent in one century, BPD in another, but Appignanesi doesn't really examine what that reason is.

She does say that "therapies [...] can create their own best patients," and she seemed nearly as skeptical of modern SSRIs and cognitive-behavioral therapy as she does of tooth removal and pelvic surgery. Despite her graphic descriptions of blood-vomiting hysterics, she sometimes seems to think that mental illness is largely illusory, something imposed by doctors on women going through normal life phases like adolescence and childbirth. The only therapies she seems to support are journaling, psychoanalysis (with some reservations), and just growing out of your problems.

Appignanesi makes good points at the beginning of her book about the inherent sexism of early psychiatric theories. She might have used these insights to examine how modern-day therapists might transcend gender stereotypes and treatment fads to give their patients the best possible care. Instead, she seems to consider almost all mental health treatments to be forms of insidious social programming. Of course, psychotherapy does tend to reinforce social norms even as it helps patients deal with their very real pain. Whether the two necessarily go hand in hand is an interesting question. It's too bad Appignanesi doesn't make a serious effort to answer it.

Mad, Bad, And Sad: A History Of Women And The Mind Doctors [Amazon]

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]

Researchers used data from the Nord-Trondelag Health study that included information about the drinking habits and mental health of more than 38,000 participants. They found that those who reported no alcohol consumption during a two-week period were more likely to report depression than moderate drinkers (defined by the U.S. Department of Health and Human Services as drinking no more than one drink a day for women, and no more than two for men. Of course, standards may be different in Norway).

The highest risk for depression was found among the group who called themselves "abstainers." Researchers are not sure how to explain this. Indeed, it seems strange that depression would be found among those who do not self medicate with alcohol. We have become used to associating alcoholism with depression, so it is surprising to have abstinence linked to mental illness as well. Researchers also found that 14% of the abstainers had previously been heavy drinkers, which kind of makes sense, but does not explain the connection for the other 86%. The only explanation suggested by the authors of the study is that, in societies where drinking is common, even normal, abstinence may be associated with the socially marginalized, or with particular personality traits that are associated with depression.

But all hope is not lost for the non-drinking depressed folk: Some scientists believe that depression may serve an evolutionary function. Various studies have found that people in a depressed mood are better at solving problems, both social and mathematical. An article published last week in Scientific American expounds on the theory that the tortuous ruminations that characterize the severely depressed may in fact aid in problem solving. The critical thinking involved in depression may have lead our brains to evolve with a predisposition toward sadness. "The capacity to feel presumably helps us solve problems and survive, and is essential for group living, and perhaps inconsolable depression is simply emotional baggage that tags along with the good stuff. Or maybe unhappiness and a tendency towards suicide is the product of the uncontrolled nature of our quicksilver minds," wrote Meredith Small in an article for LiveScience last year.

Alcohol Abstinence Linked To Depression [UPI]
Why Did Evolution Produce Depression [LiveScience]
Depression's Evolutionary Roots [Scientific American]

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]

Newser's Lindsey Tanner writes that although previous research indicated that about 2% of preschoolers suffer depression at some point, researchers didn't know if this depression could become chronic in kids so young. To determine this, the study followed 306 preschoolers, 75 of whom had major depression. They found that in 64% of children who were depressed at the start of the study, depression continued or recurred six months later. 40% were still suffering a full two years later. The findings are surprising because, as study author Dr. Joan Luby says, many psychologists thought "children under 6 were too emotionally immature to experience" depression.

The researchers found that toddlers were most likely to be depressed if they had depressed mothers, or if they had suffered abuse or the death of a parent. Psychiatrist Dr. Helen Egger says depression has different signs from ordinary toddler moodiness — kids seem sad even while playing, play death-themed games, throw especially violent tantrums, or become obsessively guilty over minor mistakes. However, it's not clear how clinicians should treat depressed toddlers. Some people are against prescribing drugs like Prozac to kids so young, but if left untreated, says psychiatry professor Dr. David Fassler, depression "can have a devastating and often lasting effect on a child's social and emotional development."

Early intervention may be helpful for a variety of mental illnesses, according to an article by researcher Mary E. Evans. For instance, cognitive behavioral therapy lowers the rate of depression in high-risk adolescents. But toddlers aren't teenagers, and it's not yet clear what kind of intervention might prevent their depression from becoming a lifelong problem. One thing's for sure — antidepressant use is on the rise across almost all American demographic groups, and might rise even more if more toddlers were diagnosed with depression.

Whether this is a good thing is up for debate. Many people get enormous relief from antidepressants, but the increase in their use hasn't corresponded with an overall improvement in American mental health. In fact, says Dr. Eric Caine, the suicide rate for middle-aged people in America is rising. Of course, that doesn't mean antidepressants aren't working — it could mean that life in America is just getting worse, or that the drugs aren't being prescribed to those who need them most. But since antidepressants can raise the risk of suicide in children, prescribing them to the very youngest kids isn't without its problems.

Still, depressed kids clearly need help, especially when depression starts before they even start school. Putting a face on this heart-wrenching illness is the HBO documentary Boy Interrupted (clip above), in which filmmakers Dana and Hart Perry chronicle the life of their son Evan. Evan first started talking about suicide in kindergarten, and was, according to Salon's Heather Havrilesky, "obsessed with jumping out a window." He killed himself at 15. Havrilesky calls the film "a smart, thoughtful and informative glimpse at a short life that sheds light on how tough it can be to recognize and effectively treat a kid." If Evan's life is any indication, it's a problem we still haven't solved.

Mental Illness Can Be Avoided In Youth [UPI]
Depression Affects Preschoolers [UPI]
U.S. Antidepressant Use Doubles In Decade [UPI]
Not Just A Cranky Toddler: Study Finds Depression In Children As Young As 3 [Newser]
Antidepressant Use Doubles In U.S., Study Finds [MSNBC]
Depressed Nation? [LA Times]
Critics' Picks [Salon]

A Time article on the Melanie Blocker-Stokes Postpartum Depression Research and Care Act (oddly, written by someone named Robert McNamara, presumably not the deceased former Secretary of Defense) says that although the bill doesn't specifically set aside money for postpartum depression screening, critics think screening would "naturally increase" if it passed. They say this could lead to false positives (as few as a third of women whose initial postpartum depression screen is positive actually have the disease) and unnecessary medication. Supporters of screening counter that postpartum depression is far from rare — up to one in seven moms get it — and that we routinely screen babies for conditions that are much less common. And screening might prevent tragedies like that of Melanie Blocker-Stokes, the act's namesake, who jumped off a building when her child was 3 1/2 months old.

It's hard to argue with increased funding for research into a condition that kills some new mothers and plunges many more into misery — not to mention putting babies at risk. At the same time, there's something a little "Yellow Wallpaper"-y about assuming that all women are in danger of flying off the handle and harming themselves or their kids. Psychologist Paula Caplan notes that adjusting to motherhood is tough, and we shouldn't assume that everyone who has some difficulty with it is mentally ill. Rather, we "should be addressing the social factors causing women to be upset after they give birth, not locating the problem within the women." Women's studies professor Ingrid Johnston-Robledo offers a similar opinion: "We need to find a way to come down in the middle: acknowledge women's depression but not assume that all women who struggle with the transition to motherhood are depressed." But that would mean developing a measured, considered response to a potentially divisive issue. Can we do that in this country?

The Melancholy Of Motherhood [Time]

According to the LA Times, the American Psychiatric Association recently discussed applying the term to "people who feel they have been wronged by someone and are so bitter they can barely function other than to ruminate about their circumstances." Some argue that these feelings can be strong enough to constitute a mental illness akin to post-traumatic stress disorder, with the difference that while people with PTSD usually feel fear and anxiety, people with post-traumatic impediment disorder feel a desire for revenge.

Dr. Michael Linden, who named the disorder, says it occurs in 1 to 2% of people, usually those who have worked hard and suffer an unexpected setback. He says the embittered "feel the world has treated them unfairly. It's one step more complex than anger. They're angry plus helpless." He also says they rarely seek treatment, because they feel that an unjust world, and not their own attitude, is the problem.

Most of us have felt this way at times, and we may be entering an especially embittered era as many hard-working people lose their jobs and their savings. Putting a name to how they're feeling may help some people, and if it's true that, as Linden says, post-traumatic embitterment disorder can lead to murder in extreme cases, it's worthy of further study. On the other hand, most people who are bitter don't murder their families, and it would be unfortunate if post-traumatic bitterness disorder became just another "excuse for bad behavior" (as Sadie argues sex addiction has become). In addition, it might actually be harder for some people to snap out of their bitterness if they're convinced they have a disorder. As with all mental illness diagnoses, post-traumatic bitterness disorder may help people find relief if applied scrupulously. If thrown around willy-nilly, however, it may just make people feel — or act — worse by pathologizing a very common feeling.

Bitterness As Mental Illness? [LA Times]

Earlier: Narcissistic Personality Disorder: Everyone's Doing It

The story is about men who commit mass-murders and suicides, spurred by several recent cases in which men killed their families prior to suicides. Not one expert quoted in the piece calls it love, though.

Unaccredited researchers said this, though.

For decades, psychiatrists have been studying such cases to determine what mental issues trigger this behavior. A person who kills his family could have control issues that lead him to decide the fate of the children, spouse and pets, researchers said.

Donna Cohen, a professor and head of the Violence and Injury Prevention Program at the University of South Florida, said something similar:

The person with a mental illness views his wife and children as possessions, believing, "I have to keep this. This is mine," Cohen said. "Nobody else is able to take care of them except me. If I can't control this in my life, I'll preserve it in death so that my world doesn't change. It's the psychiatric issues."

She adds that pre-murder domestic violence often plays a large role.

"People don't get involved, even when they know there's threat in violence because they believe they don't think anything will happen," Cohen said. "It's essential to get to domestic violence safe houses and be much more proactive in understanding there are people who have problems."

Louis Schlesinger, forensic psychology professor at John Jay College of Criminal Justice in New York City thinks that it's partially narcissism.

"They think they're saving their family and that they will be remembered with sympathy," Schlesinger said.

You know, like if CNN memorializes them as having killed "out of love."

Dr. Philip Resnick, director of the division of forensic psychiatry at Case Western, says that the men often suffer from mental illness which wreaks havoc on their perceptions of the world.

"They become very depressed as the breadwinner," Resnick said. "With their distorted, depressive perceptions, they feel that rather than allow their children to go hungry, they may feel they're doing a favor to take their family with them as they end their own life. ... They're not depriving them of life, they're ending what they see as an intolerable life."

Richard James Gelles, dean of the School of Social Policy and Practice at the University of Pennsylvania, agrees that it might be misplaced "altruism" derived from mental illness.

"They couldn't leave people behind to be ashamed and humiliated"

You know what none of them say? That men who kill their families do it out of love. Because they don't.

'Hopeless' Dads Kill Their Families Out Of Love, Experts Say [CNN]

Merkin has been in the news lately for her involvement with the Madoff scandal (her brother funneled money into Madoff's scheme), but her essay, "A Journey Through Darkness," covers more personal territory. She says she feels "as if in exiting the womb I was enveloped in a gray and itchy wool blanket instead of a soft, pastel-colored bunting," and that she was first hospitalized at age ten "because I cried all the time." The recent bout of depression that forms the focus of her essay was so severe that she not only lost thirty pounds but developed psychomotor retardation, moving slowly and speaking in a flat voice.

As obvious as these symptoms seem, Merkin was frustrated with how un-obvious her disease was. She writes,

The real question was why no one ever seemed to figure this grim scenario out on her own, just by looking at you. This was enraging in and of itself - the fact that severe depression, much as it might be treated as an illness, didn't send out clear signals for others to pick up on; it did its deadly dismantling work under cover of normalcy. The psychological pain was agonizing, but there was no way of proving it, no bleeding wounds to point to.

Because it lacks "bleeding wounds," Merkin feels, her illness doesn't seem real — even in comparison with other mental illnesses. Of the anorexia sufferers at her hospital, she writes,

They were clearly and poignantly victims of a culture that said you were too fat if you weren't too thin and had taken this message to heart. No one could blame them for their condition or view it as a moral failure, which was what I suspected even the nurses of doing about us depressed patients. In the eyes of the world, they were suffering from a disease, and we were suffering from being intractably and disconsolately - and some might say self-indulgently - ourselves.

But, as Carrie of ED Bites points out, "people with eating disorders are blamed for their illness, when it is even seen as an illness. Eating disorders are generally seen as some sort of failure—if not the sufferer, then clearly her parents." It's tempting to judge Merkin for assuming the anorexics have it easier, but one of the saddest things about the essay is how her illness isolates her even from other mental health patients, how she constructs a moral hierarchy of disease and puts herself at the bottom. The unfortunate reality is that, in society's moral hierarchy, all mental illness still lies at the bottom, too often ignored or dismissed as self-indulgence. This is changing, but Merkin's piece shows how deep the stigma still goes, and how difficult it is for those stigmatized to advocate for themselves — especially when their disease makes them feel that they are "a failure. A burden. Useless. Worse than useless: worthless." While Merkin's envy certainly seems misplaced, the blame for this belongs not with her but with her disease — and with the society that sometimes fails to recognize how real and serious this disease is.

A Journey Through Darkness [New York Times]
A Journey Through Darkness [ED Bites]

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]

After she gave birth to stillborn twins, Flaherty became manic, producing numerous books and even writing up and down her arms. In time, she came to feel that her recently diagnosed bipolar disorder helped her understand her patients. She says,

What made me empathic was my depressions. People's emotions were pounding me in the face. The mania is like wasps under the skin, like my head's going to explode with ideas. But the depressions help the doctor aspect of me.

Rose Styron, wife of Flaherty's patient, the late writer William Styron, agrees:

Doctors tend to see patients with an overtone of category. Alice never did. She understood Bill's depression and his movement problems. But she really understood his needs, appetites, moods, guilts, sadnesses and potential pleasures.

Now Flaherty works with deep brain stimulation, a technique used for Parkinson's disease and other movement disorders, as well as for depression. The stimulation process can have psychological side effects, and Alice is especially adept at dealing with these. "Neurology and psychiatry should be treating the same organ," she says. Especially in light of new research suggesting that medical school actually makes people less empathetic, she is extraordinary.

Flaherty's empathy seems to come both from her experiences as a patient with a difficult condition and from her bipolar disorder itself, from the "emotions pounding her in the face." Both mania and depression can be extremely hard to live with. Still, Flaherty feels her condition has helped give her skills she might not otherwise possess. This is in line with her holistic view of bipolar: "It was always alienating when people said, 'Oh, that's just bipolar illness talking.' No, hello - that's me." And while some may find comfort through separating the disorder from their sense of self, it's interesting that Flaherty prefers to think of mental illness as part of her, a characteristic with advantages and drawbacks. It's not a model for every patient, or for every disease, but it's easy to see why, for some, it might be very appealing.

From Bipolar Darkness, The Empathy To Be A Doctor [New York Times]

In addition to the difficulty of actually having a psychological disorder, the mentally ill have to deal with how other people stigmatize them, from employers who won't hire them, to friends and family who don't believe their ailments to be real, to health insurance companies that won't cover treatment. People usually divide the mentally ill into those that are violent and dangerous or weak and incompetent, and fear or disdain them accordingly.

In the study, published in the journal Psychological Science, researchers set out to see if gender stereotypes about certain disorders influence how we view the mentally ill, reports EurekAlert. Two Northwestern University psychologists conducted a study in which volunteers from around the country were given the case history of a person with mentally illness. Some read the history of Brian, a man with all the typical symptoms of alcoholism, and others read about Karen, who had a classic case of major depression. For some of the patients, Karen and Brian's names were switched in the reports, so that she was the alcoholic and he was the depressed one.

Researchers found that the subjects expressed more disgust and anger, and less sympathy, toward Brian and Karen after reading their real reports, in which they had the disorder associated with their gender. When the patients acted "out of character," with a depressed Brian and an alcoholic karen, the volunteers said they were more willing to help them and were more likely to see their illness as a genuine biological disorder, instead of just a character flaw. Knowing that gender does play a role in how society treats the mentally ill, researchers say that there should be a campaign to challenge stereotypes about the association of gender with certain disorders.

[Image via Exploding Dog.]

His And Hers: Study Examines The Role Of Gender In The Stigma Of Mental Illness [EurekAlert]

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]

As one of the founding members of the Ronettes - and lead singer Ronnie's older sister - Estelle was crucial to the group's early success. A student at FIT, Estelle helped define the group's signature bad-girl look - described to the Times by a contemporary as "really, really short skirts and...big, big, big hair" - which, in combination with their racially-mixed makeup, gave the Ronettes an exotic appeal for much of America. At their height, all three Ronettes were sex symbols living a glamorous life.

However, the group's breakup was devastating for Estelle. Ronnie married Phil Spector and later reformed the group with new backup singers. Estelle, meanwhile, began suffering from schizophrenia and was hospitalized with anorexia. Unable to care for her daughter, Estelle was occasionally homeless and the article describes periods during which "she sometimes wandered the streets of New York, telling people that she would be singing with the Ronettes in a jazz club.

When the group was inducted into the Rock and Roll Hall of Fame, her family

worried that the ceremony would overwhelm her, so one of Ms. Spector's current backup singers performed in Ms. Bennett's stead. But before the concert Ms. Bennett did give a brief acceptance speech. 'I would just like to say thank you very much for giving us this award,' she said. 'I'm Estelle of the Ronettes. Thank you.'

What's so deeply sad about this story is how very unshocking it is: we are used to former stars descending into squalor, and even more used to mentally ill people suffering in obscurity. The dramatic arc of someone who was known to us and then descended into such hardship tugs at our heartstrings mostly because it involves us; it tarnishes something we thought or remembered and so, for us, has added pathos. "Riches to rags" has a place in the narrative; mental illness and its quotidian degradations seldom do. Estelle Bennett's story is tragic not because she was once prosperous and famous; it is tragic that she was a person in pain, with a system that couldn't help her. We wish her peace - and, incidentally, thank her for some great music.

Estelle Bennett, a Singer for the Ronettes, Is Dead at 67 [New York Times]
A Life of Troubles Followed a Singer's Burst of Fame [New York Times]

Voluntary Madness: My Year Lost and Found in the Loony Bin was conceived when, after her stint living as the male alter-ego "Ned," Vincent suffered a nervous breakdown and was hospitalized as a suicide risk. The experience led Vincent to investigate the patient experience more fully when she'd recovered, and for the book she did stints in a large, urban hospital, a small private facility and a more experimental program. She found the public hospital's conditions to be shocking. Recaps the Times' review:

The staff comprises Teflon-slick professionals and brutish aides; the food is unappetizing, the bathrooms are dirty, the attempts at therapy are cursory, and a heavy reliance on major tranquilizers leaves the patients, many of them street-living incurables, barely conscious. The occasional middle-class citizen trapped in this mix quickly learns to feign recovery to escape.

Those who seek to dismiss the book as stunt journalism — as well as those who'd seek to learn from it — are both stymied by the fact that, in the course of her investigation, Vincent relapsed into serious depression, and ended the project anything but an objective observer. Which is too bad, as the Times points out, because it's an issue that bears investigation. We're at an interesting point in our cultural dialogues about mental illness, something that's been made plain by the reaction to the new TV show The United States of Tara. As you probably know, the Toni Collette vehicle centers on a woman with Dissociative Identity Disorder - more commonly known as multiple personalities. This being TV, the guises are wildly different and played for laughs, but nowadays mental-health advocates push for accurate representation of illnesses that were once regarded as an easy comedic device. There are watchdog groups who monitor such depictions carefully, and as a result current projects tend to avoid, at least Snake Pit-style dramatizations, allow characters like Tara to be relatable and successful, and throw around enough jargon to let people know they're taking it seriously.

Of course, it's a fine line. Because while no one should laugh at mental illness — it's, quite simply, not funny — I'd say that accurate depiction sometimes demands laughing with it. For those of us who've suffered from mental health problems, or whose family does, gallows humor is often a necessary means of coping. It's one of the things that separates well you from sick you. In my family, any institution is referred to as "the bin" — it makes it less scary when someone's there. I wonder if that might have been part of Vincent's motivation: reclaiming something scary by approaching it when "healthy." It doesn't shock me that this proved impossible, and in a sense, even if it derailed the project, her relapse, somewhat ironically, shows as well as anything the power and true scariness of the disease and the need to take it seriously.

Reality Intrudes on an Undercover Mental Patient [NYT]
TV’s Split Personality [Newsweek]
'Voluntary Madness' Details Life In 'Loony Bin' [NPR]

Hensley, a PhD student who is clearly quite ill, claims that she's not talking to psychologists or psychiatrists because her intellect makes her incapable of treatment. "I am always one step ahead of them," Hensley says, "I know what they are thinking and how they think they will 'cure' me." Which, as any former anorexic can tell you, is complete and total bullshit. Everyone, when deeply, deeply sick, feels like they are too smart for treatment: the illness has taken over, and the ED voice will do anything to convince us to stay away from those who might want to pull us away from our obsession.

Yet the Daily Mail paints Hensley as a brilliant and tragic mind whose story is somehow different from the stories of millions of women out there suffering from eating disorders, describing her failing health, interviewing her desperate mother, and acting surprised that someone as bright as Hensley could fall victim to anorexia. It is just another in a series of disgusting media interviews with incredibly sick women; a freak show designed to shock readers with images of anorexic females and tales of the dark side of eating disorders.

My issue here is this: Vikki Hensley's story, much like the story of the anorexic twins, who Entertainment Tonight breathlessly followed around for years as if they were Brad Pitt and Angelina Jolie, is not designed to help anybody. Instead, it is designed to add a mysterious glamour to the illness, a n"Oh, isn't this awful? Let's post more shocking pictures" treatment that dehumanizes the victim and adds yet another misconception to the disease: that it is a peculiar "choice" that some women make, and not a serious mental illness.

Hensley's quotes are painfully familiar: she claims that she enjoys being mistaken for a young girl, and that her weight is a sign that she's "very good at dieting", which feeds her drive for perfectionism. She is, sadly, a textbook anorexic: everything she's said, I once said, as did the women who were hospitalized with me during my illness. We all thought we were too smart for treatment, we all strove for perfectionism, we all allowed the ED voice to speak on our behalf. Yet at some point, we recognized that our illness had taken control, and we took the steps to gain that control back.

Not so for Vikki Hensley, who, after attempts to go into recovery at a hospital, now keeps herself going with a caloric intake that "allows her to function 'normally.'" Hensley is still very sick: she has not had a period in years and still speaks only in the language of the illness, noting that "The thought of having a period makes me feel unclean, and while I want to have children, having periods isn't something I want to have to deal with. In my ideal world, I would only have a period when in the future I want children, not now." Her desperate need to return to a pre-pubescent state, where her body remains androgynous, is something many fellow anorexics are all too familiar with.

We are supposed to empathize with Hensley, and to a point, I do. But mostly, these types of articles piss me off more than anything else: Vikki Hensley is mentally ill, and on the path to death from her illness, yet the Daily Mail celebrates her willingness to barely squeak by in the name of her career, as if we should think she's some kind of hero for being able to juggle her anorexia and her coursework at the same time. I should clarify that my anger is not directed at Vikki, but rather her illness, which is leading her to believe that she's doing the right thing, and the Daily Mail for shamelessly trumpeting said illness. Nobody should be held up for being sick: this type of thing only validates her existence as "Vikki The Anorexic" instead of Vikki the Person, and sadly, every time we parade sick women around as tragic heroes, we are only feeding the illness and potentially egging them on toward their death.

It breaks my heart to read such things: Vikki's story and her words are things I've heard a million times, words I've used myself. Yet I was fortunate enough to escape the strange media fascination with the illness: nobody ever praised me for being mentally ill, or celebrated the fact that I had found a way to barely survive while continuing my "commitment" to anorexia. One can only hope that Vikki, sooner rather than later, will get the help she really needs. God knows she's not going to get it from exploitative articles like this.

Why I Starved Myself To Have The Body Of A 12-Year-Old [DailyMail]