Peter H Brown Clinical Psychologist

Exercise and Mood: Healthy Activity Can Help Beat Depression and Anxiety (Repost)

“On its own, exercise does appear to have significant effects in terms of elevating mood,” says Dr. Andrew Leuchter, professor of psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior. Physical activity, he adds, is often used to augment treatments such as medication and cognitive behavioral therapy. “If people are on medication or in treatment and haven’t had a complete recovery from depression, exercise is useful in getting them all the way there.” Exercise affects the brain in several ways. “People with depression tend to become somewhat inert, and they don’t engage in their usual activities, and exercise gets people back to their usual level of activity,” Leuchter says. That can prompt an upward cycle, inspiring people to return to work and connect again with friends and family, ultimately providing motivation to stay on course. Such connections are crucial for depressed people.

“The psychological benefits make a big difference from my perspective,” says James Blumenthal, professor of medical psychology at Duke University in Durham, N.C. “People have a greater sense of being in control. They feel better about themselves and have more self-confidence.”

A physical change can instigate a mental change, says Vaccaro, director of development at Moonview Sanctuary, a psychological treatment center in Santa Monica. “When you’re getting somebody to move and getting them to change a pattern in their life, just that little bit of pattern change can relate to a mood change, and they start to see themselves as a person who is active, not just a couch potato. They change their perception.” There may be direct physical effects on the brain as well. The treatment center encourages exercise — yoga in particular — as a way to manage many types of mood disorders. Besides having a strong mind-body connection, “yoga is something that can be modified to someone’s activity level and is something they can do throughout their life,” Vaccaro says.

Mood elevation

Several studies illustrate the benefits of exercise.In one, published in the journal Psychosomatic Medicine in 2007, 202 men and women with major depression were randomly assigned to participate in a supervised exercise program in a group setting, do home-based exercise, take an antidepressant medication or take a placebo pill. After 16 weeks, 41% were in remission, meaning they no longer had major depressive disorder. Those who were in the exercise and medication groups tended to have higher remission rates than the placebo group.

Another study examined how much cardiovascular exercise was needed to see changes in mood among those with mild to moderate major depressive disorder. The 80 men and women who took part in the research were randomly placed in four exercise groups that varied in the number of calories burned and the frequency of the activity. A placebo group did flexibility exercises three days a week. Those in the group that exercised at moderate intensity three to five days a week for about 40 minutes (consistent with public health recommendations) showed the biggest decrease in depressive symptoms compared with those who exercised less, or just did stretching.

The 2005 study appeared in the American Journal of Preventive Medicine. Other pieces of the puzzle are still missing, however. Scientists aren’t sure what changes happen in the brain — and why — when people exercise. Many scientists and physicians believe that exercise increases levels of serotonin, a neurotransmitter thought to be linked to mood regulation. However, most of the studies supporting this have been done on animals. “It’s hard to quantify it in humans for a number of reasons,” Leuchter says. “We don’t entirely understand exactly why patients get depressed in the first place. We have theories, but it’s hard to know in individual cases. And we don’t have a good way of looking at [changes] in the brain.” Scientists do know that exercise causes an increase in blood flow to the brain and raises the amount of energy the brain uses. And even though the link between blood flow and mood isn’t known, Leuchter says, “the brain in general seems to be in a healthier state.”

Activity is key

Exercise may be key in fighting depression, but no generic prescription fits everyone. Overall health and exercise history factor into what kind of regimen might be prescribed. “If someone was a runner, I’d get them back to running,” Leuchter says. “If not, I’m not going to have the goal of turning someone into a major athlete. I’d simply want to get them active, and even walking around the block might be good.” Those who aren’t currently in treatment for depression should consult with a physician before exercising to make sure they have no underlying health problems. Patients who are on medication or in therapy for depression shouldn’t consider exercise a substitute for either treatment. “The key,” Blumenthal says, “is really maintenance. You have to do it on an ongoing basis. You should find something you enjoy, but doing something is better than nothing.”

March 11, 2010 Posted by peterhbrown | Uncategorized | 1 Comment

This is Water: Are Persistence,Tolerance, Compassion and Mindfulness the Keys to Resilience and Happiness? (Repost)

Today I have been re-reading the late David Foster Wallace’s 2005 Commencement Speech to Kenyon College Students. David Foster Wallace, the brilliant American author who sadly suicided in late 2008, had a brilliant way of cutting through the ‘crap’ and his writings have a way of taking your mind to deeper places that would be obvious and evident if we actually took the time to notice what was going on not just within us, but for those around us. Aside from his award winning novel ‘Infinite Jest’, Foster Wallace’s Commencement Address remains one of his greatest legacys to us. As the text is is the public domain, I have taken the liberty of posting it in its entirety below. Read it, and I hope it reaches you the same way it has me and many of my patients and clients.

Transcription of the 2005 Kenyon Commencement Address – May 21, 2005

(If anybody feels like perspiring [cough], I’d advise you to go ahead, because I’m sure going to. In fact I’m gonna [mumbles while pulling up his gown and taking out a handkerchief from his pocket].) Greetings [“parents”?] and congratulations to Kenyon’s graduating class of 2005. There are these two young fish swimming along and they happen to meet an older fish swimming the other way, who nods at them and says “Morning, boys. How’s the water?” And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes “What the hell is water?”

This is a standard requirement of US commencement speeches, the deployment of didactic little parable-ish stories. The story [“thing”] turns out to be one of the better, less bullshitty conventions of the genre, but if you’re worried that I plan to present myself here as the wise, older fish explaining what water is to you younger fish, please don’t be. I am not the wise old fish. The point of the fish story is merely that the most obvious, important realities are often the ones that are hardest to see and talk about. Stated as an English sentence, of course, this is just a banal platitude, but the fact is that in the day to day trenches of adult existence, banal platitudes can have a life or death importance, or so I wish to suggest to you on this dry and lovely morning.

Of course the main requirement of speeches like this is that I’m supposed to talk about your liberal arts education’s meaning, to try to explain why the degree you are about to receive has actual human value instead of just a material payoff. So let’s talk about the single most pervasive cliché in the commencement speech genre, which is that a liberal arts education is not so much about filling you up with knowledge as it is about quote teaching you how to think. If you’re like me as a student, you’ve never liked hearing this, and you tend to feel a bit insulted by the claim that you needed anybody to teach you how to think, since the fact that you even got admitted to a college this good seems like proof that you already know how to think. But I’m going to posit to you that the liberal arts cliché turns out not to be insulting at all, because the really significant education in thinking that we’re supposed to get in a place like this isn’t really about the capacity to think, but rather about the choice of what to think about. If your total freedom of choice regarding what to think about seems too obvious to waste time discussing, I’d ask you to think about fish and water, and to bracket for just a few minutes your skepticism about the value of the totally obvious.

Here’s another didactic little story. There are these two guys sitting together in a bar in the remote Alaskan wilderness. One of the guys is religious, the other is an atheist, and the two are arguing about the existence of God with that special intensity that comes after about the fourth beer. And the atheist says: “Look, it’s not like I don’t have actual reasons for not believing in God. It’s not like I haven’t ever experimented with the whole God and prayer thing. Just last month I got caught away from the camp in that terrible blizzard, and I was totally lost and I couldn’t see a thing, and it was fifty below, and so I tried it: I fell to my knees in the snow and cried out ‘Oh, God, if there is a God, I’m lost in this blizzard, and I’m gonna die if you don’t help me.'” And now, in the bar, the religious guy looks at the atheist all puzzled. “Well then you must believe now,” he says, “After all, here you are, alive.” The atheist just rolls his eyes. “No, man, all that was was a couple Eskimos happened to come wandering by and showed me the way back to camp.”

It’s easy to run this story through kind of a standard liberal arts analysis: the exact same experience can mean two totally different things to two different people, given those people’s two different belief templates and two different ways of constructing meaning from experience. Because we prize tolerance and diversity of belief, nowhere in our liberal arts analysis do we want to claim that one guy’s interpretation is true and the other guy’s is false or bad. Which is fine, except we also never end up talking about just where these individual templates and beliefs come from. Meaning, where they come from INSIDE the two guys. As if a person’s most basic orientation toward the world, and the meaning of his experience were somehow just hard-wired, like height or shoe-size; or automatically absorbed from the culture, like language. As if how we construct meaning were not actually a matter of personal, intentional choice. Plus, there’s the whole matter of arrogance. The nonreligious guy is so totally certain in his dismissal of the possibility that the passing Eskimos had anything to do with his prayer for help. True, there are plenty of religious people who seem arrogant and certain of their own interpretations, too. They’re probably even more repulsive than atheists, at least to most of us. But religious dogmatists’ problem is exactly the same as the story’s unbeliever: blind certainty, a close-mindedness that amounts to an imprisonment so total that the prisoner doesn’t even know he’s locked up.

The point here is that I think this is one part of what teaching me how to think is really supposed to mean. To be just a little less arrogant. To have just a little critical awareness about myself and my certainties. Because a huge percentage of the stuff that I tend to be automatically certain of is, it turns out, totally wrong and deluded. I have learned this the hard way, as I predict you graduates will, too.

Here is just one example of the total wrongness of something I tend to be automatically sure of: everything in my own immediate experience supports my deep belief that I am the absolute center of the universe; the realest, most vivid and important person in existence. We rarely think about this sort of natural, basic self-centeredness because it’s so socially repulsive. But it’s pretty much the same for all of us. It is our default setting, hard-wired into our boards at birth. Think about it: there is no experience you have had that you are not the absolute center of. The world as you experience it is there in front of YOU or behind YOU, to the left or right of YOU, on YOUR TV or YOUR monitor. And so on. Other people’s thoughts and feelings have to be communicated to you somehow, but your own are so immediate, urgent, real.

Please don’t worry that I’m getting ready to lecture you about compassion or other-directedness or all the so-called virtues. This is not a matter of virtue. It’s a matter of my choosing to do the work of somehow altering or getting free of my natural, hard-wired default setting which is to be deeply and literally self-centered and to see and interpret everything through this lens of self. People who can adjust their natural default setting this way are often described as being “well-adjusted”, which I suggest to you is not an accidental term.

Given the triumphant academic setting here, an obvious question is how much of this work of adjusting our default setting involves actual knowledge or intellect. This question gets very tricky. Probably the most dangerous thing about an academic education — least in my own case — is that it enables my tendency to over-intellectualize stuff, to get lost in abstract argument inside my head, instead of simply paying attention to what is going on right in front of me, paying attention to what is going on inside me.

As I’m sure you guys know by now, it is extremely difficult to stay alert and attentive, instead of getting hypnotized by the constant monologue inside your own head (may be happening right now). Twenty years after my own graduation, I have come gradually to understand that the liberal arts cliché about teaching you how to think is actually shorthand for a much deeper, more serious idea: learning how to think really means learning how to exercise some control over how and what you think. It means being conscious and aware enough to choose what you pay attention to and to choose how you construct meaning from experience. Because if you cannot exercise this kind of choice in adult life, you will be totally hosed. Think of the old cliché about quote the mind being an excellent servant but a terrible master.

This, like many clichés, so lame and unexciting on the surface, actually expresses a great and terrible truth. It is not the least bit coincidental that adults who commit suicide with firearms almost always shoot themselves in: the head. They shoot the terrible master. And the truth is that most of these suicides are actually dead long before they pull the trigger.

And I submit that this is what the real, no bullshit value of your liberal arts education is supposed to be about: how to keep from going through your comfortable, prosperous, respectable adult life dead, unconscious, a slave to your head and to your natural default setting of being uniquely, completely, imperially alone day in and day out. That may sound like hyperbole, or abstract nonsense. Let’s get concrete. The plain fact is that you graduating seniors do not yet have any clue what “day in day out” really means. There happen to be whole, large parts of adult American life that nobody talks about in commencement speeches. One such part involves boredom, routine, and petty frustration. The parents and older folks here will know all too well what I’m talking about.

By way of example, let’s say it’s an average adult day, and you get up in the morning, go to your challenging, white-collar, college-graduate job, and you work hard for eight or ten hours, and at the end of the day you’re tired and somewhat stressed and all you want is to go home and have a good supper and maybe unwind for an hour, and then hit the sack early because, of course, you have to get up the next day and do it all again. But then you remember there’s no food at home. You haven’t had time to shop this week because of your challenging job, and so now after work you have to get in your car and drive to the supermarket. It’s the end of the work day and the traffic is apt to be: very bad. So getting to the store takes way longer than it should, and when you finally get there, the supermarket is very crowded, because of course it’s the time of day when all the other people with jobs also try to squeeze in some grocery shopping. And the store is hideously lit and infused with soul-killing muzak or corporate pop and it’s pretty much the last place you want to be but you can’t just get in and quickly out; you have to wander all over the huge, over-lit store’s confusing aisles to find the stuff you want and you have to maneuver your junky cart through all these other tired, hurried people with carts (et cetera, et cetera, cutting stuff out because this is a long ceremony) and eventually you get all your supper supplies, except now it turns out there aren’t enough check-out lanes open even though it’s the end-of-the-day rush. So the checkout line is incredibly long, which is stupid and infuriating. But you can’t take your frustration out on the frantic lady working the register, who is overworked at a job whose daily tedium and meaninglessness surpasses the imagination of any of us here at a prestigious college.

But anyway, you finally get to the checkout line’s front, and you pay for your food, and you get told to “Have a nice day” in a voice that is the absolute voice of death. Then you have to take your creepy, flimsy, plastic bags of groceries in your cart with the one crazy wheel that pulls maddeningly to the left, all the way out through the crowded, bumpy, littery parking lot, and then you have to drive all the way home through slow, heavy, SUV-intensive, rush-hour traffic, et cetera et cetera.

Everyone here has done this, of course. But it hasn’t yet been part of you graduates’ actual life routine, day after week after month after year.

But it will be. And many more dreary, annoying, seemingly meaningless routines besides. But that is not the point. The point is that petty, frustrating crap like this is exactly where the work of choosing is gonna come in. Because the traffic jams and crowded aisles and long checkout lines give me time to think, and if I don’t make a conscious decision about how to think and what to pay attention to, I’m gonna be pissed and miserable every time I have to shop. Because my natural default setting is the certainty that situations like this are really all about me. About MY hungriness and MY fatigue and MY desire to just get home, and it’s going to seem for all the world like everybody else is just in my way. And who are all these people in my way? And look at how repulsive most of them are, and how stupid and cow-like and dead-eyed and nonhuman they seem in the checkout line, or at how annoying and rude it is that people are talking loudly on cell phones in the middle of the line. And look at how deeply and personally unfair this is.

Or, of course, if I’m in a more socially conscious liberal arts form of my default setting, I can spend time in the end-of-the-day traffic being disgusted about all the huge, stupid, lane-blocking SUV’s and Hummers and V-12 pickup trucks, burning their wasteful, selfish, forty-gallon tanks of gas, and I can dwell on the fact that the patriotic or religious bumper-stickers always seem to be on the biggest, most disgustingly selfish vehicles, driven by the ugliest [responding here to loud applause] (this is an example of how NOT to think, though) most disgustingly selfish vehicles, driven by the ugliest, most inconsiderate and aggressive drivers. And I can think about how our children’s children will despise us for wasting all the future’s fuel, and probably screwing up the climate, and how spoiled and stupid and selfish and disgusting we all are, and how modern consumer society just sucks, and so forth and so on.

You get the idea.

If I choose to think this way in a store and on the freeway, fine. Lots of us do. Except thinking this way tends to be so easy and automatic that it doesn’t have to be a choice. It is my natural default setting. It’s the automatic way that I experience the boring, frustrating, crowded parts of adult life when I’m operating on the automatic, unconscious belief that I am the center of the world, and that my immediate needs and feelings are what should determine the world’s priorities.

The thing is that, of course, there are totally different ways to think about these kinds of situations. In this traffic, all these vehicles stopped and idling in my way, it’s not impossible that some of these people in SUV’s have been in horrible auto accidents in the past, and now find driving so terrifying that their therapist has all but ordered them to get a huge, heavy SUV so they can feel safe enough to drive. Or that the Hummer that just cut me off is maybe being driven by a father whose little child is hurt or sick in the seat next to him, and he’s trying to get this kid to the hospital, and he’s in a bigger, more legitimate hurry than I am: it is actually I who am in HIS way.

Or I can choose to force myself to consider the likelihood that everyone else in the supermarket’s checkout line is just as bored and frustrated as I am, and that some of these people probably have harder, more tedious and painful lives than I do.

Again, please don’t think that I’m giving you moral advice, or that I’m saying you are supposed to think this way, or that anyone expects you to just automatically do it. Because it’s hard. It takes will and effort, and if you are like me, some days you won’t be able to do it, or you just flat out won’t want to.

But most days, if you’re aware enough to give yourself a choice, you can choose to look differently at this fat, dead-eyed, over-made-up lady who just screamed at her kid in the checkout line. Maybe she’s not usually like this. Maybe she’s been up three straight nights holding the hand of a husband who is dying of bone cancer. Or maybe this very lady is the low-wage clerk at the motor vehicle department, who just yesterday helped your spouse resolve a horrific, infuriating, red-tape problem through some small act of bureaucratic kindness. Of course, none of this is likely, but it’s also not impossible. It just depends what you what to consider. If you’re automatically sure that you know what reality is, and you are operating on your default setting, then you, like me, probably won’t consider possibilities that aren’t annoying and miserable. But if you really learn how to pay attention, then you will know there are other options. It will actually be within your power to experience a crowded, hot, slow, consumer-hell type situation as not only meaningful, but sacred, on fire with the same force that made the stars: love, fellowship, the mystical oneness of all things deep down.

Not that that mystical stuff is necessarily true. The only thing that’s capital-T True is that you get to decide how you’re gonna try to see it.

This, I submit, is the freedom of a real education, of learning how to be well-adjusted. You get to consciously decide what has meaning and what doesn’t. You get to decide what to worship.

Because here’s something else that’s weird but true: in the day-to day trenches of adult life, there is actually no such thing as atheism. There is no such thing as not worshipping. Everybody worships. The only choice we get is what to worship. And the compelling reason for maybe choosing some sort of god or spiritual-type thing to worship — be it JC or Allah, bet it YHWH or the Wiccan Mother Goddess, or the Four Noble Truths, or some inviolable set of ethical principles — is that pretty much anything else you worship will eat you alive. If you worship money and things, if they are where you tap real meaning in life, then you will never have enough, never feel you have enough. It’s the truth. Worship your body and beauty and sexual allure and you will always feel ugly. And when time and age start showing, you will die a million deaths before they finally grieve you. On one level, we all know this stuff already. It’s been codified as myths, proverbs, clichés, epigrams, parables; the skeleton of every great story. The whole trick is keeping the truth up front in daily consciousness.

Worship power, you will end up feeling weak and afraid, and you will need ever more power over others to numb you to your own fear. Worship your intellect, being seen as smart, you will end up feeling stupid, a fraud, always on the verge of being found out. But the insidious thing about these forms of worship is not that they’re evil or sinful, it’s that they’re unconscious. They are default settings.

They’re the kind of worship you just gradually slip into, day after day, getting more and more selective about what you see and how you measure value without ever being fully aware that that’s what you’re doing.

And the so-called real world will not discourage you from operating on your default settings, because the so-called real world of men and money and power hums merrily along in a pool of fear and anger and frustration and craving and worship of self. Our own present culture has harnessed these forces in ways that have yielded extraordinary wealth and comfort and personal freedom. The freedom all to be lords of our tiny skull-sized kingdoms, alone at the center of all creation. This kind of freedom has much to recommend it. But of course there are all different kinds of freedom, and the kind that is most precious you will not hear much talk about much in the great outside world of wanting and achieving and [unintelligible — sounds like “displayal”]. The really important kind of freedom involves attention and awareness and discipline, and being able truly to care about other people and to sacrifice for them over and over in myriad petty, unsexy ways every day.

That is real freedom. That is being educated, and understanding how to think. The alternative is unconsciousness, the default setting, the rat race, the constant gnawing sense of having had, and lost, some infinite thing.

I know that this stuff probably doesn’t sound fun and breezy or grandly inspirational the way a commencement speech is supposed to sound. What it is, as far as I can see, is the capital-T Truth, with a whole lot of rhetorical niceties stripped away. You are, of course, free to think of it whatever you wish. But please don’t just dismiss it as just some finger-wagging Dr. Laura sermon. None of this stuff is really about morality or religion or dogma or big fancy questions of life after death.

The capital-T Truth is about life BEFORE death.

It is about the real value of a real education, which has almost nothing to do with knowledge, and everything to do with simple awareness; awareness of what is so real and essential, so hidden in plain sight all around us, all the time, that we have to keep reminding ourselves over and over:

“This is water.”

“This is water.”

It is unimaginably hard to do this, to stay conscious and alive in the adult world day in and day out. Which means yet another grand cliché turns out to be true: your education really IS the job of a lifetime. And it commences: now.

I wish you way more than luck.

DAVID FOSTER WALLACE

Buy the full text in Hardcover Form Here or if you are an Australasian Resident you might like to Purchase Here: This Is Water: Some Thoughts, Delivered on a Significant Occasion, about Living a Compassionate Life

March 9, 2010 Posted by peterhbrown | Uncategorized | Leave a comment