The Doctor Is In
Posted on October 12, 2018 Leave a Comment
Hallo there, sweethearts. If you feel like I may have ghosted you for a bit, I place the blame solely on Dave. He’s getting out of hand. You know how it goes. But I’m back now, and I have a special guest. No, Dave, it isn’t you. I swear. Right! Before we dive in—I don’t want you to get any ideas, I know how you are—here’s a friendly disclaimer:
The below represents the opinions of psychologist Jerry Vanzant Walker, III, Ph.D., and not the opinions or beliefs of the United States Air Force or the entire field of professional psychology.
As you might have guessed by now, the special guest is Dr. Jerry Walker! You might remember months ago when I released a two-part series on mood and anxiety disorders (part I—part II). Well, this is a bit of a follow-up to that. We’ve focused on the science and on the individuals suffering these types of disorders, so now we’re getting another POV.
Now, if you’ve dealt with any chronic or recurring disease/disorder, I’d be willing to bet that going through the gauntlet of finding a doctor has been a fucking nightmare. That’s just the way it is, sadly. Trying to find medical help—whether mental or physical—can be extremely frustrating. There’s a disconnect somewhere. Whether we like doctors or not, we subconsciously place them on a pedestal. We expect them to know everything about anything that could be wrong with us because, I mean, doctor. You know? Well, surprise! That’s not how it works. Something we need to remember when seeking medical help is that medical professionals are people too. Calm your tits, Dave, I know it’s a revelation.
Meet the Psychologist
Dr. Walker is a licensed psychologist who’s been working (both active duty and as a contractor) for the USAF for the past six years. He earned his BA in Psychology and BS in Communication Studies from the University of Texas—where he was also a male cheerleader—and earned his Ph.D. in Counseling Psychology & Human Systems from Florida State University. Dr. Walker always had a desire to serve the military. He started talking to recruiters while in high school, but his parents were adamant that he go to college first. The study of psychology always fascinated him, but in undergrad it became his passion. In grad school, his program’s Director of Clinical Training (a former Navy psychologist) asked if Dr. Walker had ever considered working for the VA or military.
After entering the Air Force for his psychology residency in San Antonio, Dr. Walker spent the remainder of his career at Langley Air Force Base in southeast Virginia. He works as an embedded psychologist and behavioral/human factors consultant for a large intelligence organization on the Langley Air Force Base. As if that weren’t enough, he also has a local part-time private practice. The work ethic is strong with this one.
Throughout his military career, Dr. Walker has run an outpatient substance abuse program, a 25-person multidisciplinary outpatient mental health clinic, a suicide prevention program for 11,000 personnel at a military installation, and a disaster mental health team which responded to eight crises. He has also served as the sole psychologist for 9,000+ American, British, Canadian, and Australian military personnel in a deployed location. Dr. Walker’s graduate research and personal proclivity toward resilience and performance enhancement—vs treatment or remediation of deficits—led him to pursue opportunities within the military to work with special operations forces and other communities which might benefit from having an in-house psychological consultant.
When he isn’t working, Dr. Walker spends time with his wife and son. He’s a bit of an outdoorsy guy who enjoys kickboxing, playing racquetball and guitar, and reading fantasy. I mean, he’s legit a real person. Not a cyborg or robot or Pleadian. Damn Pleadians.
Diagnosis from a new POV
I’ve heard a good deal of horror stories when it comes to getting a diagnosis and finding the right treatment. I’d make a joke about one of the side effects of trying to get a correct diagnosis being a sharp pain in the ass, but I’m realizing it’s becoming my own personal cliché. Which you’d know if you read Rise and Run. So never mind. Joke aborted, shameless plug ended. In any case, I wanted to provide a new POV on the diagnosis process so that we can get a better understanding of, you know, the whole process.
According to Dr. Walker, diagnostics is a continual process that involves listening to what the patient says—or doesn’t say—and knowing the right questions to ask and how to ask them. “Most mental health professionals use the Diagnostic and Statistical Manual, 5th Edition (DSM-5) as a guide when making a diagnosis,” says Dr. Walker. “Mental health disorders are described generally in terms of clusters of symptoms, so in order for a patient to meet diagnostic criteria, they generally have to endorse a sufficient number of symptoms from various clusters or categories.”
Dr. Walker usually utilizes the first session to try to get a general sense of what the patient is experiencing and the timeline/progression of symptoms. “It may be several sessions before we are able to trace [an individual’s] presenting concerns to their etiology,” says Dr. Walker. When this happens, he will sometimes provide a general (e.g. Unspecified Anxiety Disorder) or tentative diagnosis until there is enough information to either rule in or rule out a diagnosis with more certainty. “Sometimes a patient won’t reveal certain symptoms or experiences they’ve had or are having until much later on in treatment, because they didn’t believe them to be relevant to their presenting concern,” Dr. Walker explains. “Additionally, we have to determine the extent and severity of functional impact of these symptoms, as this is a core component of mental health diagnoses.”
Dr. Walker notes that empathic listening is critical to both fostering a collaborative, working relationship with a patient and determining accurate diagnoses. “It also helps to have general working knowledge of the DSM-5, though I do keep a pocket reference book nearby in case I need to refer to the diagnostic criteria for some of the rarer disorders.”
You can see the empathy, right?
Trick or Treatment
So, we’ve gone through the diagnosis process and now we get to the fun part. Treatment! Or, rather, a whole host of attempted treatments that are less than stellar, followed by a winner. At least, that’s generally the patient’s experience. I asked Dr. Walker about the path to treatment and whether the original diagnosis could change depending on what worked and what didn’t. “Contemporary psychological practice emphasizes the use of evidence-based practices (i.e. psychological treatment procedures that are widely supported by a series of sound research studies) for the treatment of specific mental health conditions,” Dr. Walker says. “Depending on the complexity, acuity, coping resources, insight, etc. of the patient and their mental health condition(s), treatment can vary widely in terms of scope and longevity. I’ve helped folks ameliorate chronic PTSD in as little as four one-hour sessions. I’ve also worked with an individual with childhood-related PTSD and Borderline Personality Disorder on a weekly basis for nearly two years (with relatively minor ultimate progress).” There’s also an aspect of patient commitment and patient-therapist relationship impacting the efficacy of treatment: “The stronger these are, generally the better the outcome.”
I want you to pay close attention to this next bit. There’s an important message there. “Psychologists do not prescribe medication [usually] but they do advocate for their patients and refer them to prescribing mental health providers when appropriate,” Dr. Walker says. Advocate. That’s fantastic. It’s great if you can find a healthcare pro who will advocate for you, but I want to stress that it is even more important for you to advocate for yourself. The more proactive you are when dealing with health problems and the more you advocate for yourself, the more likely you’ll be able to find a healthcare pro or team that will be willing to advocate for you. What’s that, Dave? Oh, yes. Got distracted. Back to the path … of treatment! “Typically, a general class of medication will be selected for treatment of specific mental health conditions. There does seem to be some evidence that specific drugs within a class are more indicated for a specific condition than others,” Dr. Walker says. “They also may have different effects/side effects (e.g., Zoloft, an SSRI, has been deemed safe for use to treat depression during pregnancy, though Prozac, also an SSRI, is not).”
And, as it turns out, the original diagnoses can change based on medication responses/non-response. “There are some cases I’ve seen where a prescriber gives a medication that reveals the diagnosis was entirely different. An SSRI prescribed for depression set off a manic episode, wherein it was discovered the patient did not have unilateral depression but actually a bipolar disorder.”
Pictured: What happens when you don’t advocate for yourself.
Mental Health and Violence
One mental health conversation that pops up periodically (mostly sensationalized in the media) is mental health in relation to extreme acts of violence—after mass shootings or spree killings, for instance. “Believe it or not, acts of violence are rarely related to mental health disorders such as depression, PTSD, or schizophrenia as the popular media might have you believe,” says Dr. Walker. “In actuality, substance abuse has a far higher contribution to self-harm, domestic violence, child abuse, and sexual assault.” I can’t say that’s surprising. The way the media presents most mental health discussions is a detriment to both the understanding and perception of mental health issues. Come, plebes, let us take a journey in the Way Way Back machine because I want to reference a particular mass shooting. If we look at the case of Charles Whitman, he obviously knew something was wrong. He sought help. It was only after his death that an autopsy (requested in his suicide note) revealed a tumor that “conceivably could have contributed to his inability to control his emotions and actions,” according to the Connally Commission. So, I guess my question is: At what point during the diagnosis/treatment phase is it determined that a patient’s symptoms are from, say, chemical imbalance issues vs something like a tumor or brain injury? Well good news, kids, because that’s a question Dr. Walker and his ilk are trained to consider.
“In most of the diagnostic criteria in the DSM-5, there is a line that asks whether the presenting symptoms could be better explained by a medical condition or the effects of a medication,” explains Dr. Walker. “This requires the psychologist to have a basic working knowledge of neuroanatomy, psychopharmacology, and neuropsychology, which allows us to ask appropriate questions to rule out the possible influence of these variables on the [individual’s] presenting condition.” If the psychologist deems it appropriate, they will refer the individual to another provider for additional assessment/testing to clarify the root cause of the presenting symptoms. “This has happened several times in my career. I once referred a patient to his primary care physician to request an MRI based on the patient’s reported onset of severe headaches and display of pseudobulbar affect—random, uncontrollable laughing and crying. A patient with a mild traumatic brain injury from an automobile accident six years prior developed OCD. One time I had a patient present with hypomanic symptoms (super happy, talkative, goal-directed, restless, etc.) who, it turned out, was abusing Adderall he got from his roommate.” Dr. Walker doesn’t have admitting privileges or the ability to refer patients for certain medical tests, so in cases like those mentioned above, he consults with other medical providers and encourages them to investigate further.
‘Member that scene from Infinity War? You’re welcome.
Things, they are A-Changin’
Over the past few years, more people have joined the campaign to be open about mental health. “I get the feeling that there are a lot of misconceptions about mental health disorders, though I’ve seen mental health stigma gradually decrease in the general population over the last decade,” Dr. Walker says. “Mental health disorders are, by definition, abnormal. This has a negative connotation, but in truth all this means is that mental health disorders are not the predominant function of our brains or behavior. As with any minority condition or trait, this makes understanding the experiences of someone with a mental health condition difficult for the majority who do not have this personal experience or exposure.”
As we talk about mental health issues more frequently and in a more open-minded and educated manner, we gradually begin to lessen the stigma. “The millennial generation seems to be more prone to talking about mental health issues and advocating for disenfranchised/minority members, including those who suffer from relatively rare mental health conditions like OCD, schizophrenia, and Bipolar Disorder,” says Dr. Walker.
If you or someone you know is struggling with any type of mental health issues, reach out, talk about it, and seek help. You are not alone.
Mood and Anxiety Disorders: Part Two (the People)
Posted on July 16, 2018 1 Comment
Hallo, hallo, and happy Monday. Or just normal Monday. Dave says, “Melancholy Monday,” but we don’t really want to entertain anything Dave says. He’ll start to think he’s people. Welcome to part two of Mood and Anxiety Disorders. We’re past the science dump and onto the human side of these disorders. Three volunteers participated in an interview, the questions of which were essentially the same in order to get a scope of how differently these disorders affect individuals.
From the top, I want to give a huge thank you to the participants—whose names I will be changing for privacy purposes.
Internal Struggles
The first task I asked of my participants was to try to describe what their depressive and anxiety episodes felt like and whether they differed from day to day. The participants included one male (based in Alabama), and two females (one based in California, and one in Florida). So, going forward, the participants will be called Alabama, California, and Florida. It’s nice when I don’t have to be creative and make up actual names.
Both Alabama and Florida suffer from depression and anxiety. If you remember from the previous post, anxiety and depression tend to show up together, first one, then the other. The symptoms of these disorders also overlap quite a bit. While California suffers from anxiety, her chances of battling depression in the next few years are statistically higher than average.
So, what does depression and anxiety feel like, day to day, for our participants?
Alabama: The depression feels like you’re all alone, no one cares, and you’d be better off not being here. The anxiety makes me feel like I can’t breathe, like I’m going to cave in on myself. I don’t want to be around anyone. It’s different day to day. Some days I don’t want to leave the house and others I’m just fine and seem normal to everyone, but inside I’m screaming.
Florida: My anxiety feels like someone is sucking the life out of me. Having anxiety and anxiety attacks are very scary. Recently I had three very bad attacks where I thought I was having a heart attack and needed to go to the hospital. I ate tums, drank cold water, laid down, and focused on my breathing. It lasted roughly 15 minutes, then the next one came on and same thing happened. I had to take my prescribed medication and eventually fell asleep and slept for several hours. I was okay after that.
My depression is a feeling of just being in a funk and not wanting to do anything or go anywhere. After my dad passed in December 2017, I became really depressed and was diagnosed with severe depression. If I was talking to someone, I would just burst into tears for no reason. I would sleep a lot and didn’t want to take a shower—it didn’t even cross my mind until my husband asked me if I took one that day. The depression and anxiety differ from day to day. Some days/weeks I do not leave my house, I don’t talk to anyone (I used to be a social butterfly and talk to a lot of people, now I don’t). I am withdrawn from life. I don’t sleep well and can fall asleep anywhere from 11 pm to 3 am. At night my mind races and I can’t get it to slow down (even with meds) enough to relax and fall asleep.
California: Anxiety has different types of feelings or levels. Some days it’s no big deal. When I’m dealing with a lot of stress at work, with the kids, etc., it’s harder to sleep. I find my mind can’t stop thinking about whatever the problem is. Sometimes, even if nothing is going wrong, I have anxiety about what could potentially go wrong.
Insomnia and losing the will to do anything are common symptoms of depression and anxiety. These two symptoms feed a cycle that exacerbates depressive episodes especially. You can see this is cases of insomniacs suffering depressive episodes, though they might not be clinically depressed. In the most basic of terms: Lack of sleep can fuck you up. The lack of will to do the things you normally love is crippling. At a certain point, it turns into a lack of will to do anything and the less you do, the worse the depressive episode can become.
Florida: Depression is every day, really. It is just learning to focus on you and say, “Today is going to be a good day,” and accomplish one task. Just doing one task a day helps me a lot and I end up doing more sometimes.
External Struggles
Individuals suffering from depression and anxiety aren’t just battling internally. Getting medical help, getting understanding, the pressure of trying to hide the illness is sometimes brutal. I asked our participants when they first realized something was wrong, when they sought help, and what frustrations they encountered while seeking treatment.
Alabama: I was about 12 [when I realized something was wrong]. I was 15 when I started receiving help. Then I stopped, thinking I’d be fine. It wasn’t until ’09 that I received the proper help I really needed. It was a slow, tedious process to find out what I would fit best [in terms of medication]. The first med was Lexapro. It is evil. I became meaner and angrier and gained a shit-ton of weight on it. I was then put on Wellbutrin, and it has been the best thing for me.
California: I want to say in my early 20s I noticed an issue with [anxiety]. Shortly after having kids. I still haven’t sought professional help. I’ve just realized in the past year that I need to do so. I plan to next week. Since I haven’t been “clinically diagnosed,” I’ve self-medicated for years without even knowing. I always drink before bed so that my mind doesn’t keep me awake. I’ve smoked pot before, but all it does is make me paranoid, which makes the anxiety worse.
Florida: I initially had my first bout with depression when I was 16, after my grandmother committed suicide. I lost weight, was tired all the time, slept a lot, cried a lot. We were out of town for a week and all I did was cry and yell to “go home.” The next week I didn’t go to school because I was physically sick. The next time it happened I was in my early 20s and I just felt low and disconnected. I went back to the doctor right away and went back on meds. I have been on/off throughout my life. This stint has been the longest, since I had my back surgery in July 2014. I really don’t know what happened, but I just don’t feel like the same person after the surgery.
The frustrations of being diagnosed are always being asked, “Do you want to end your life? Do you want to hurt yourself or other(s)?” In my opinion, I wouldn’t be seeking help if I was suicidal. I have already been through it, and I know the devastation it causes for a family/others left behind. The thought has never crossed my mind—I never wanted my parents to have to have the hurt of losing a child.
Throughout the process of getting diagnosed and then finding the right medication, individuals have to struggle through fighting certain perceptions of depression and anxiety. This added external pressure sometimes keeps sufferers from seeking help in the first place. Sometimes that turns out okay … And other times, not so much. Suicide is often associated with depression and there are plenty of clinical studies to back that up, but it’s different for every individual. For some individuals, suicide is never a conscious thought—it’s a snap decision (and I hesitate to really even call it a decision). For other individuals, it’s just not an option. And, for some individuals, it’s a plague of a thought. Regardless, it’s not comfortable when you seek help and the first question is, “Are you suicidal?” It is a question that needs to be asked, but it’s also a stigma associated with depression.
Clearing up Misconceptions
Friends and family can be some of the biggest tools in an individual’s arsenal while going through depressive or anxious episodes. Tools … in the toolbox. Weapons in the arsenal. Mixing metaphors again. The point is, it’s very helpful when the people you surround yourself with understand what depression is, what anxiety is, and are able to be supportive. I asked our participants how their friends and families treated them and what the biggest hurdle is when dealing with these disorders
Alabama: My family treated me like I was angry all the time. Well, I was. Friends are more understanding—they know why and what has conspired in my life to cause it to be worse as I’ve gotten older. I have a few friends that can tell when a really bad episode will take place. My biggest hurdle dealing with these [disorders] are people not understanding why I feel the way I do. It’s like, “You can get over it and be fine.” Okay, that’s not the case. People call you crazy or a nut case—which may be true, but they don’t know what causes it.
Florida: My mom suffers from both depression and anxiety also, my sister has been diagnosed with depression since my dad became ill, my dad was on depression and anxiety meds, my grandfather is on depression meds since my dad has passed. It is hereditary on both sides of my family, unfortunately. My husband has suffered from both also, so he is understanding. [My biggest hurdle is] trying to overcome it, trying to have a “normal” life again. I don’t like taking pills and having to keep track of when I need more and of doctor appointments. I just want things to be okay again. I hate being like this. It makes my brain run slower, and I can’t think of the answers to questions as quickly. Especially when someone asks what I want to do–I don’t really want to do anything. I isolate myself, so I don’t have to be forced into a situation where I have to respond because it’s exhausting. Also eating maybe 1.5 meals a day, having no appetite. Trying to smile or laugh daily. I can’t remember the last time I laughed, seriously. My depression has gotten a lot worse since I lost my dad, too.
California: [Friends and family] treat me normal, I guess. I talk to my mom about it more than anyone and she sympathizes more than anyone. I think she has the same issue. [My biggest hurdle] is trying not to think something is wrong. Every time things are going right, I get scared because it’s too good.
Well, it’s about time to wrap this up, folks. The final question I asked our participants is what they want people to understand about depression and anxiety. I think it’s a fitting place to leave off, since it offers a neatly-packaged take-away to the series. You’re welcome.
Alabama: I want people to understand that we do suffer from the illness and have no control over it except with medication. This isn’t something that can be turned on and off like a light switch. Those who have loved ones that do suffer, try to be understanding—we don’t mean to be harsh or reclusive or angry. It’s the chemical imbalance we were born with, or perhaps a traumatic experience. Whatever the case, educate yourselves on our behalf so you’ll get a better understanding of why we act the way we do.
Florida: It is a real illness, it is not fake. Anyone who suffers with depression and/or anxiety didn’t ask for either one of these illnesses. It can be debilitating for some people and consume their life. I would like them to answer these questions:
- Do you enjoy getting up and going to a job every day and socializing with people?
- Do you like making money? Could you survive on $500-1,200 a month?
- Do you like going to the doctor and being reminded to get medications and when to take them?
- Do you enjoy going anywhere and not having a breakdown? Being able to breathe and not gasping for air, or not crying at the drop of a hat?
- Do you like to be reminded to shower daily, to accomplish one task a day?
So… It’s nap-time, now, right?
Mood and Anxiety Disorders: Part One (the Science)
Posted on July 9, 2018 1 Comment
Hallo, darlings. I feel like we had so much fun in our previous discussion on depression that we should do it again! My last post came from a personal place and was definitely one-sided. Well, I’ve decided we need to split the difference between the science behind depression and speaking with sufferers. And not just depression, but anxiety disorders as well. Mood and anxiety disorders have numerous overlapping symptoms and often having one will lead to eventually suffering from the other.
I mentioned last time that depression isn’t an emotion—it’s a state being. So now, I’ll back that up with the—drumroll, please, Dave—science around depression and anxiety. As with any kind of neuroscience, nothing it completely concrete here. Every day we are learning more about the brain. Having said that, the clinical studies included in this post reflect the most in-depth researched and medically accepted causes for depression and anxiety.
Serotonergic and Noradrenergic Systems
The prevailing science behind depression and anxiety disorders centers around serotonin and norepinephrine dysfunction. When you first get on an antidepressant, chances are it’s an SSRI (selective serotonin reuptake inhibitor) or SNRI (serotonin and norepinephrine reuptake inhibitor), which is usually prescribed before MAOI (monoamine oxidase inhibitor) or atypical antidepressants. Depending on who you talk to, SSRIs—though having the least side effects—are probably the least viable option long term. In an overview in Depression and Anxiety, Charles B. Nemeroff, M.D., Ph.D., states: “There has been increasing evidence […] that antidepressants that inhibit both norepinephrine and serotonin reuptake (SNRI) are more effective in severe and refractory depression than those that inhibit uptake of a single monoamine neurotransmitter. In addition, patients with major depression treated with dual reuptake inhibitors may achieve remission more frequently than those treated with single monoamine reuptake inhibitors.” Conversely, depressive episodes for patients on SSRIs often hit harder. In the event you think you have depression and are about to look for treatment, be ready for a whirlwind of ups and downs before you get the right meds.
Of course, there’s more to it than just serotonin and norepinephrine dysfunction. In Role of Serotonergic and Noradrenergic Systems in the Pathophysiology of Depression and Anxiety Disorders, Nemeroff and Kerry J. Ressler explain: “There is abundant evidence for abnormalities of the norepinephrine (NE) and serotonin (5HT) neurotransmitter systems in depression and anxiety disorders. […] The underlying causes of these disorders, however, are less likely to be found within the NE and 5HT systems, per se. Rather their dysfunction is likely due to their role in modulating, and being modulated by, other neurobiologic systems that together mediate the symptoms of affective illness.”
It’s important not to think of depression and anxiety as something you can through pills at and be done with. These illnesses are more complicated than that and their origins are not singular. Continues Nemeroff and Ressler: “Disrupted cortical regulation may mediate impaired concentration and memory, together with uncontrollable worry. Hypothalamic abnormalities likely contribute to altered appetite, libido, and autonomic symptoms. Thalamic and brainstem dysregulation contributes to altered sleep and arousal states. Finally, abnormal modulation of cortical-hippocampal-amygdala pathways may contribute to chronically hypersensitive stress and fear responses, possibly mediating features of anxiety, anhedonia, aggression, and affective dyscontrol.” When dealing with depression and anxiety, it is important to rule out symptoms that are caused be a secondary problem.
It’s in Your Genes … And Environment
I’m assuming we all know the nature vs nurture argument, especially pertaining to mental illnesses. And, as with most cases to which this argument can be applied, the likelihood of suffering depression or anxiety are both attributed to nature and nurture. Nemeroff and Elizabeth B. Binder, M.D., Ph.D, explain: “Susceptibility to depressive or anxiety disorders is now well established to be due to the combined effect of genes and the environment, with heritability estimates for these disorders ranging from about 30% to 40%. The CRF system, being highly responsive to the environment, has been posited to serve as a key interface between environmental stressors and the development of depression.”
Research based on Hopelessness Theory and Beck’s Theory further back up this claim. The team behind Cognitive Vulnerability-Stress Theories of Depression: Examining Affective Specificity in the Prediction of Depression Versus Anxiety in Three Prospective Studies posits that: “According to the cognitive vulnerability-stress component of HT, a depressogenic cognitive style is hypothesized to interact with negative life events to contribute to increases in depressive symptoms. In HT cognitive vulnerability is conceptualized as a tendency to make negative inferences about the cause […] consequences, and meaning for one’s self-concept, of a negative life event. Similarly, BT posits a vulnerability-stress component in which dysfunctional attitudes are hypothesized to interact with negative events to contribute to elevations of depressive symptoms. In BT, cognitive vulnerability is conceptualized as depressive self-schemas containing dysfunctional attitudes, such as one’s worth derived from being perfect or needing approval from others.”
For non-sufferers, it is important to realize that depression and anxiety are not normal emotional responses. They are abnormal, and out of sufferer’s control. Saying something like, “Relax,” or, “You’re overreacting,” to someone who suffers from depression or anxiety only serves to alienate the sufferer more.
Complex Illnesses
I wanted part one of this series to really show that depression and anxiety are not personality defects, not cries for attention, not someone being overly dramatic or sensitive. Although, sure, there are some of those types of people scattered about. Depression and anxiety stem from the very genetic level of the sufferer. And from there, it’s a cycle. You’re genetically predisposed to negativity and so you find it everywhere, which doubles down on depressive or anxious episodes.
Part two of this post is going to balance out the science with the human aspect. We’ll be getting a peek into the lives and struggles of individuals suffering from depression, anxiety, or both.
Be on the lookout for part two next Monday!
Depression Is …
Posted on June 28, 2018 Leave a Comment
Hallo, darlings. I’ll skip with the “long time, no talk” jabber and dive right into it. Today, Dave and I are bringing you a super fun topic: depression. And since Dave is sitting in the corner chewing Barbie heads like a feral man-child, I guess I’ll be doing most of the work. This post is coming a bit late following the media blowout of the suicides of Anthony Bourdain and Kate Spade—don’t start with the conspiracy theories, Dave—but this post isn’t exactly about suicide (most of which are not media worthy). Since depression can lead to suicide, the two topics can often go hand in hand.
Anyway, since this is already getting pretty dark, what say we get started!
Right, so, depression means different things to different people. Those who have never experienced it typically don’t understand it. Those who have experienced it … well, they don’t typically understand it either. I’m going to avoid the neurochemical and/or physiological aspects of depression, because that’s not really what I want to focus on. Also, because I’m not only referring to clinical or diagnosed depression. What I want to focus on is being depressed, the state of depression as it affects an individual.
Understanding the Cause
To understand the cause of depression, you have to be able to understand that in some cases … there is no cause. Sure, the whole chemical imbalance or specific brain region trauma/abnormality blah blah blah—yes, those are identifiable causes for depression. But, in some cases, depression just is. It’s there. You can follow the thread of it back to the onset only to find a wall. So, then, why are you depressed?
In my opinion, that is one of the most harmful questions for someone going through an episode of depression. It’s an ignorant question asked from—likely—good intentions. And yet, if the sufferer has no identifiable cause, it’s a question that’s impossible to answer. Trying to answer it can make the sufferer feel inadequate, even stupid. It’s such a simple question, after all. One the sufferer likely asks his/herself throughout the depressive episode.
Understanding Depression
Depression and sadness are often used interchangeably. While sadness can become depression, the two are not the same (shocking revelation). Sadness is an emotion; depression is the pushing down of your entire personality. “I feel sad,” vs “I am depressed.” It seems an insignificant differentiation on the page (or screen). It’s not (another shocking revelation).
Now, I’m just your average country bumpkin (sarcasm), so explaining how depression feels is hard. In fact, the only way I can think to explain depression is through a more creative route. So, give me a second to dust the cult off my creative writing shoes (shameless plug for upcoming book Commonality Sanctum) and let’s see if I can’t wow you with some poetic prose. But not actually poetry because, you know, I have a reputation.
Depression is …
Depression is despondency, but it’s more than that and it’s less than that.
Depression is the lack of fire, the lack of fight.
Depression is the loss of will, the loss of passion.
Depression is the total blackout that blinds you to who you were before the episode and who you want to be again.
Depression is laughing for hours with your best friend and then, in the five seconds of conversational stillness, getting lost.
Depression is wanting to go home … but you’re already there.
Depression is staring at the wall, because what else is there?
Depression is the stone on the stone on the stone on the stone on your chest, weighing you down.
Depression is not caring, because caring requires a spark of something that isn’t there, not right now.
Depression is waiting around for the episode to end, but you aren’t holding out much hope.
Depression is, “I don’t want to do this.”
Depression is, “I can’t do this.”
Depression is, “Why even try?”
Like I said at the top, super fun content today. If you know someone who is suffering from depression, reach out to them. If you are a sufferer having an episode, just keep in mind there are numerous crisis hotlines. And remember, the storm will pass, but you have to be alive to appreciate it.
Review of Stellar Fusion, by E.L. Strife
Posted on June 10, 2018 Leave a Comment
The first in E.L. Strife’s Infinite Spark series, Stellar Fusion follows an elite military-like team on its mission to save Earth from the Suanoa, who have already subjugated numerous alien species. The team’s leaders, Sergeants Nakio Atana and Jameson Bennett, must overcome their differences and work together if they have any hope of keeping their team alive. The stakes are raised even higher when they discover the slaves being held on the Suanoan vessel. While among these slaves, Atana begins to piece together mysteries from her past.
Stellar Fusion is an action-packed space opera—the stakes are high, the relationships are intense, and the heroes are over-the-top. Strife creates a world that is fun to explore and inhabits it with unique species and interesting characters. The concepts explored are simultaneously familiar and unique. It’s a book that makes you want to know what’s going to happen next.
As much as I enjoyed Stellar Fusion, I do have a few issues to address. At times, the prose could get a bit confusing—unclear descriptions, curious word choices, and lots of POV hopping. While the story itself is good enough to overcome these issues, there were times it detracted from the overall readability.
All in all, Stellar Fusion is a fun, fast-paced space romp that’s definitely worth a read. I look forward to the next installment.
Italian Inspired Cabbage Rolls
Posted on May 7, 2018 4 Comments
Cabbage Rolls
Servings: 4
Per serving:
370 calories
27g (46%) Protein
13g (22%) Fat
19g (32%) Carbs
Ingredients:
- 16 oz Ground Beef (the leaner the better)
- 2 ½ cups Broccoli Florets
- ¼ tsp Minced Garlic
- ½ medium Purple Onion (diced)
- 12 oz Pasta Sauce (of your choice)
- Olive Oil
- 8 large Cabbage Leaves
- Salt and Pepper (to taste)
- Parmesan Cheese (optional)
Hallo again, little kitchen dwellers. I chose today’s recipe because… well, honestly, I’d already written most of it out for a friend and so it was the quickest and Mondays are my busiest days, so here we are. These cabbage rolls are easy and pretty quick to make. Also, quite good. And, you know, healthy. But let’s cut the chatting and get right to it. Are you ready?
- Grab a skillet and set in on a burner, then turn that burner to about medium to medium-high. When the skillet gets all nice and toasty, throw your ground beef on it. While the beef is cooking, go ahead and blanch the broccoli florets. After the great blanching, chop the florets up. You want pretty small chunks, so maybe dice instead of chop. Once the meat is about 95 percent done, drain it, throw it back into the skillet, and add the broccoli.
- If your purple onion isn’t already diced, then make that shit happen. Grab a new skillet and heat about ½ tsp of olive oil over medium-high heat. Add garlic. Sweat the garlic for about 30 seconds. Add your onions (which at this point should definitely be diced). Sauté onions for about three minutes, then add them to your beef and broccoli mix.
- Pour pasta sauce into the mix until heated throughout. Add salt and pepper to taste.
(Side note: If you want to fancy it up a bit because the sauce you chose just isn’t giving you the flavor profile you want, then feel free to add your preferred herbs/spices.)
- Cool, so, set your meat mix aside and grab a large pot so you can start boiling some water. You should have eight large cabbage leaves that have been thoroughly rinsed so you don’t die of dirt and pesticides and such. Boil each leaf for about 3 minutes (or until leaf is soft). Depending on the size of your pot, you can boil several leaves at once. This is your show, do it how you want. As long as it’s right. I mean, I’m going to assume you know enough to make educated decisions. Are your leaves done yet? Jesus, finally!
- Add about ½ cup of the meat mixture to each cabbage leaf. You want them full, but not exploding. As you roll the cabbage leaf, remember to tuck in the ends. If you don’t know how to roll a cabbage leaf, check out this 20 second video.
- Since technically these are already fully cooked and ready to eat, the finishing cook is really for texture. Mine, pictured above, were finished off in my air fryer, which gave a crispy texture to the rolls. You can also finish them for about five minutes on medium-high in a skillet with a little olive oil (suggested). Or, you could finish them in the oven on 325˚ for about seven minutes. Totally your call here.
- Top cabbage rolls with parmesan cheese (optional).
Review of Return to Wonderland, by Tanya Lisle
Posted on May 3, 2018 Leave a Comment
Tanya Lisle’s Return to Wonderland catches up to Alice years after she first fell down the rabbit hole. She has since endured a barrage of doctors and learned to put her adventures in Wonderland behind her. She’s finally free to attend the prestigious Lucena Academy to get a fresh start—and make friends her own age.
Unfortunately, a purple-haired boy appears at the school, revealing himself to be the Cheshire Cat. He speaks in riddles about how Wonderland is a much different place than when Alice last visited and tempts her with a visit back.
Lisle managed to modernize the world in and around Wonderland in a way that doesn’t detract from the story. It feels like a legitimate expansion of the original and, though a children’s book, is not boring or cumbersome for the adult side of the reader equation. It’s a very quick and easy read. The quality of prose is engaging, and the book has great pacing overall.
Alice is an easy character to cheer on. Her moments of doubt and her bout of nerves when meeting new people are easily relatable during the target age-range for this book, and her strength makes her all the more endearing. The supporting cast, Adrianna and her brothers specifically, feel like parallels of characters in Wonderland—so they are at once new and familiar. The Cheshire Cat himself seems to represent the changes in Wonderland. As the story progresses, Cat’s actions mirror in the normal world the changes occurring in Wonderland.
There are, of course, familiar faces in Wonderland, as well. As Alice goes through Wonderland she begins to see the changes of which the Cheshire Cat hinted. Although she is more prepared for Wonderland this time around, the changes present fresh new problems for Alice to navigate.
Fajita Power Bowl
Posted on April 26, 2018 2 Comments
Fajita Power Bowl
Servings: 4
Per serving:
575 calories
43g (40%) Protein
32g (30%) Fat
33g (30%) Carbs
Bowl Ingredients:
- 2 cups Riced Cauliflower
- 1 cup Cooked Black Beans (you can use fresh, canned, or dry)
- 1 large Red Bell Pepper (thinly sliced)
- 1 large Orange Bell Pepper (thinly sliced)
- 1 large Yellow Bell Pepper (thinly sliced)
- 1 medium Purple Onion (thinly sliced)
- 4 tbsp Sour Cream
- 1 tsp Minced Garlic
- Olive Oil
- 1 packet Fajita Seasoning
- Salt and Pepper (to taste)
Guacamole Ingredients:
- 4 oz Avocado (after peeling and pitting)
- ½ medium Purple Onion
- ½ medium Tomato
- 1 medium Jalapeno
- 1 tbsp Lemon Juice
- 2 tbsp Cilantro
- ¼ tsp Dill Weed
- 1 tsp Oregano
- Salt and Pepper (to taste)
Alright you beautiful cooks … no, chefs! Let us begin. First up: The guacamole! Now, I make my guac using a food processor, but if you don’t have one (we’re equal access here at the blog that apparently discusses everything) I would suggest a blender. If you’re using a blender, I’d advice blending the onion, tomato, and jalapeno first, then adding the avocado, cilantro, and lemon juice. Otherwise, here were go!
- Add avocado (peeled and pitted), purple onion, tomato, jalapeno, lemon juice, and cilantro to your food processor (see above fore blender suggestions) and pulse until smooth. (Side note: For creamier consistency, add more avocado. If you’re looking for more of a salsa-guac, add more tomato.)
- After your guac is at your preferred consistency, mix in salt and pepper (to taste), dill weed, and oregano.
(Side note: I like to add a pinch of Hellfire Salt for a smoky flavor.) - Got your guac all to taste now? Good! Go put that shit in the fridge!
Now, lets move on to the bowl components. First of all, you’re going to need to rinse out your food processor so you can rice some cauliflower. Unless you bought that shit already riced at the store, in which case, I mean … that’s cool. Why put any effort into it? Just kidding, I know you’re busy. Anyway, let’s get moving!
- Get your steak. Rinse it, pat it as dry as you can, then rub a little salt and pepper on both sides. Heat a skillet to high. Once the skillet is hot, add in your olive oil. Once the oil is nice and hot, place your steak into the pan. Let it hang out for about two minutes on each side, then remove it. You don’t want it completely cooked yet, just a nice sear on the outside. You’ll be finishing the cook on it later. For now, just set it aside on a plate and forget about it. Don’t slice it. Just leave it, whole, on a plate somewhere, and forget it.
- The pan you just seared the steak in? Keep it on that hot burner, and don’t rinse it out yet. You’re about to do some sautéing in it, so if you think you need to add a little more olive oil, go for it. First, add your garlic to the pan and sweat for about 20 seconds. Add onion slices. Sauté onion for about 1 minute. Add red, yellow, and orange bell pepper slices and sauté for another minute, constantly stirring. Turn the burner to down to medium, stir in salt and pepper to taste. Cook for about five minutes, then turn the heat to low and forgetaboutit.
- Get another pan. Heat that mofo up on medium-high. Add a smidge of olive oil to the hot pan. Once oil is hot, add cauliflower. Stir constantly. Cook for about 3-5 minutes. Remove from heat.
- Go back to your peppers and onions. Take them out of the pan and set them on a plate. Slice your steak (can be as thin or thick as you want), then add it to the pan from which you just removed the peppers and onion. You should not need to add any oil at this point. Turn heat to medium-high. Add ½ cup of water to the pan and half of the packet of fajita seasoning. Stir thoroughly. Once water is boiling, reduce heat to low. Cook until water is absorbed. This should give you medium-rare steak slices. Once done, remove from pan.
- So, your cauliflower and your cooked black beans. You want to mix these together. I’d suggest using the steak and peppers pan if it’s large enough. On medium-low heat, mix cauliflower and black beans. In a bowl, mix ¼ cup water with the remaining fajita seasoning until the seasoning is completely dissolved. Pour seasoning into cauliflower/black bean mix. Cook until seasoning is completely absorbed. Remove from heat.
- Now the fun part! Assembling the bowl! Divide cauliflower/black bean mix between four bowls (or containers, if you want to save a serving or three as leftover meals). Add the pepper/onion mix, again dividing four even portions. Next, add the beef slices. Plop on your sour cream, then top it off with your homemade guac. Voila! You’re done!
- Eaaaaat iiiiiiit.
The Subject That’s Making a Killing
Posted on April 19, 2018 Leave a Comment
Serial killers! We’re interested! Why? I’ve been meaning to write this post for a little over a week now, but I’m a writer so … procrastination is part of the job. Luckily, I’ve got Dave here to keep me on track. Sometimes. Well, when he feels like being a productive member of society.
So, serial killers—a topic that never goes out of style. In fact, we tend to make celebrities of serial killers. You want proof? Look no further than the numerous podcasts, books, documentaries, and movies that discuss the lives and works of these murderous bastards.
In his 2017 article, Why Americans are so Fascinated with Serial Killers, David Schmid says:
Without wanting to minimize the difference between celebrating fictional and real-life serial killers, the impact of Silence [of the Lambs] demonstrates vividly the American obsession with serial murder, which by the 1990s had developed to a point where the serial killer had become a dominant presence in our popular culture, a figure that inspired not only fear and disgust, but also a mixture of fascination and even a twisted kind of identification.
Consider the fact that Charlize Theron played the homely Aileen Wuornos, that Jeremy Renner played Jeffrey Dahmer, that former teen heartthrob Zac Efron is set to play Ted Bundy. That attractive A-listers are playing such loathsome characters is a Hollywood gimmick to capitalize on people’s interest in serial killers. People tend to like—and are better able to sympathize with—attractive people. On top of that, we’re juxtaposing the character onto the actor and if we like the actor, that only makes us more receptive to sympathizing with the character—you know, the serial killer.
Oh, God, Kermit! Why!
But, what sparks that initial interest? Why do we all recognize the names John Wayne Gacy, Ted Bundy, and H. H. Holmes, the noms de guerre Son of Sam, Jack the Ripper, and Boston Strangler? Why are these boogeymen so prominent in our culture?
Media Influence
Society’s interest in serial killers is not recent and, in fact, started well before the term ‘serial killer’ was coined. “When the crimes of H.H. Holmes […] came to light in 1894, it seemed that America had its very own version of Jack the Ripper. The fact that Hearst newspapers paid Holmes $10,000, an extraordinary sum at the time, for his confession testifies to the immense public interest in the case,” says Schmid. The mystery serial killers present forces us to ask our favorite question: Why?
This is a question media platforms were only too happy to answer. In his 2017 article, Our Curious Fascination with Serial Killers, Scott A. Bonn, Ph.D. explains, “Highly stylized and pervasive news media coverage of real-life serial killers and their horrible deeds transforms them into […] celebrity monsters.” Add in the fact that fictional serial killers are now just as pervasive in pop culture as actual serial killers and things start getting, dare I say, catawampus. “Exaggerated depictions of serial killers in the mass media have blurred fact and fiction. As a result, real-life killers such as Jeffrey Dahmer and fictional ones like Hannibal “The Cannibal” Lecter have become interchangeable in the minds of many people.”
This mingling of fact and fiction helps us distance ourselves from feeling threatened, as we can now place this larger-than-life monster in an entertainment context and forget that there’s around a dozen distinctly not-Hannibal-Lecter-type serial killers operating in the US at any given time. Much like going through a haunted house during Halloween, we can watch movies about serial killers and enjoy the thrill of fear, but ultimately that fear is removable, it’s distanced. It’s only entertainment.
Are you not entertained?
Prevailing Theories
One theory regarding our interest in serial killers is that the topic tickles our survival instinct. That instinct, when it comes to serial killers, revolves around that pesky question again: Why? According to Bonn:
The average person who has been socialized to respect life, and who also possesses the normal range of emotions such as love, shame, pity, and remorse cannot comprehend the workings of a pathological mind that would compel one to abduct, torture, rape, kill, engage in necrophilia, and occasionally even eat another human being. The incomprehensibility of such actions drives society to understand why serial killers do incredibly horrible things to other people who often are complete strangers. As such, serial killers appeal to the most basic and powerful instinct in all of us—that is, survival. The total disregard for life and the suffering of others exhibited by serial killers shocks our sense of humanity and makes us question our safety and security.
Another theory is that, well, we’re kind of morbid. In Andrew Hankinson’s article, This is Why We are All so Obsessed with Serial Killers, criminologist Elizabeth Yardley explains: “It’s that train wreck, car crash sort of thing, where you don’t want to look but you do anyway. It’s something we call ‘wound culture’. We’re drawn to the trauma and suffering of other people and there’s an awful lot of that around serial murder.”
The idea that we want to see something gruesome—as long as it involves someone else—can be repugnant, but the evidence is there to support it. There are myriad videos of beheadings, automobile accidents, extreme sports accidents, and websites like Documenting Reality. Just Googling a serial killer will pull up images of crime scenes and victims. Media, survival instinct, and wound culture may play roles in our interest in serial killers, but my own theory is that our interest strikes a little closer to home.
Wait, empathy can cause physical pain? No thanks, I’m out.
There but for a Head Injury go I
It’s estimated that about one percent of the general population suffers from psychopathy and four percent from sociopathy. Sounds small, but that’s over seven million people and over 300 million respectively, worldwide. That’s a lot of goddamn crazy. Not all psychopaths and sociopaths are violent and—specifically in the case of sociopaths—violent tendencies have a lot to do with upbringing. I don’t want to dwell on the nature vs nurture aspect—because Jesus Christ that would last a while—but many serial killers have the common thread of shitty, sad, abusive, and in some cases downright horrific childhoods. Another common thread? Head wounds.
An abusive childhood and a head injury … Things that could happen to anyone. We tend to see these commonalities and dismiss the neurochemical or neurophysiological aspects of psychopathy and sociopathy. According to Bonn, “The serial killer represents a lurid, complex and compelling presence on the social landscape. There appears to be an innate human tendency to identify or empathize with all things—whether good or bad—including serial killers.” The more similar we are to an individual—whether real or perceived similarities—the easier empathy becomes.
This empathy leads us to question our own capabilities. Professor Alexandra Warwick states: “Being interested in why other people do things is always being interested in what we’re like ourselves. The projection onto others and the consideration of what that is, it’s absolutely about what we’re like. Are we capable of those things?” There’s something about tapping those dark thoughts that’s enticing. Everyone gets angry at one point or another and many people have reached the point of rage. For the most part, we shake it off and move on. But what if we didn’t? What if we couldn’t?
Our interest in serial killers is a mirror of our interest in our own darkness. “Could I murder someone?” “Do I have what it takes?” “Are my own morals keeping me from this behavior or is it the law?” “Could whatever drove that other person to murder also drive me to murder?” They are questions you don’t want ask out loud, and yet it’s a curiosity that bubbles up. “Arguably, the serial killer identity is a mirror reflection of society itself,” says Bonn. “As such, there are things the rest of us can learn about ourselves from the serial killer if we look beyond the superficial ‘monster’ image depicted in the mass media.”
Since the question “why?” isn’t likely to be answered anytime soon, society’s interest in serial killers probably won’t be on the wane for quite a while.
Review of The Scavenger, by J. L. Willow
Posted on April 12, 2018 Leave a Comment
The Scavenger is a YA coming-of-age story that revolves around four primary characters: Catherine, Samuel, Frank, and Nathan. After a series of teens OD, Nathan, an NYPD investigator, works to find the culprit dealing a new, deadly strain of marijuana. Meanwhile, Frank, a long-time drug dealer, already has his next client in his sights. He uses Samuel to peddle the drugs to high schoolers. Their next target? None other than Catherine.
I had two key issues with The Scavenger: structure and believability. The Scavenger follows four different first-person POVs and a random third-person POV of two of the characters it’s already following. The narrative never stays with any one character long enough for the reader to connect. The short chapters mean we’re switching characters too quickly. If the book had an additional 100 pages or so, this might be less of an issue for me. Each character had an intriguing history that was mostly hinted at instead of really fleshed out.
The book’s plot, the catalyst of ODs leading to the climax, is believable and a good subject to work with. However, believability stops with the drug causing the ODs: marijuana. While marijuana can cause dependency in some young individuals, it’s not widely considered addictive. Also, according to the DEA, there has never been a marijuana overdose. Technically, the marijuana in The Scavenger is a new, high-THC strain laced with cocaine. Ingesting a high content of THC does have side effects, including increased anxiety and paranoia, lethargy, hunger, cotton mouth, sleepiness—generally the effects of smoking a blunt. Of course, lacing marijuana with cocaine does make a dangerous combination because it stresses the heart, but it’s questionable as to if that would increase addiction. A healthy teen would have to smoke a lot (a lot) of cocaine-laced marijuana to OD.
(Side note: Cocaine isn’t invisible, so the buyer would be able to see that the weed was laced)
Having said that, if you suspend your belief (or have never really dealt with drugs) then this won’t be a problem. It wasn’t enough of a problem for me to put the book down and, as I said, it’s a good premise overall.
The Scavenger is easy to read. It’s well written and the relationship between Catherine and Samuel screams “teenage hormone-driven relationship.” There are great moments throughout the book and if this is J.L. Willow’s first novel, then I can only see her work getting better and better.
RJ Plant
