Issue 1: The Cure

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Hallo beautiful people. I’ve decided I’ll try releasing a weekly, six-panel episodic comic. The first one is a bit dark, but I hope you find a little humor in it. I’m trying to reconnect with that kid who used to draw for hours. If in the process I can entertain some folks, well then, why not? Enjoy!

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COVID-19 Prompts more Mental Health Talk

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Well, hallo and welcome back, you beautiful convergence of minds on a mission to mostly just miss the next five minutes of dead space. Empty space? Dead air. Radio silence! The state of things these days…what a shitshow. Ammiright? For the past couple of weeks, I’ve thought about writing on a few different “COVID and” topics but one stands out more than the rest. Surprise! It’s mental health.

In the past month alone, how many times have you heard someone bring up the importance of mental health? Obviously, there are many reasons why:

  • Mental instability/unrest does not a successful quarantine make
  • Isolation—it’s lonely!
  • Pandemics stir up fear and uncertainty, taking away any sense of control

According to Psychiatrists Beware! The Impact of COVID-19 and Pandemics on Mental Health, published on March 15, “Although the effects of the coronavirus on mental health have not been systematically studied, it is anticipated that COVID-19 will have rippling effects, especially based on current public reactions. On an individual level, it may differentially exacerbate anxiety and psychosis-like symptoms as well as lead to non-specific mental issues (e.g., mood problems, sleep issues, phobia-like behaviors, panic-like symptoms).” You know, all the fun ones!

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The Affected

So, what does COVID-19 mean for those of us dealing with our own mental illness(es)? Means you’ve got to put some work in, friend. I think it’s fairly safe to say that a majority of people are not in an ideal situation. You’re either out of work or overworked, living in isolation or stuck in a house with too many people, maybe you don’t have enough supplies or money, your neighbors are playing “Eye of the Tiger” way too loud on repeat and you cannot rise to the challenge again or so help you God… What? Oh, right, yes.

Regardless of what your situation might be, you’re likely going to have to put in more effort than normal (that’s more effort than you normally would, as well as more effort than “normal” people) to stay balanced. According to Managing and Understanding Mental Health Concerns During the COVID-19 Pandemic, “For some, it is or will be critical to seek out professional mental health care, especially for those who are already experiencing mental health issues like substance use disorder, depression, and anxiety. Many therapists are now offering telehealth services, so individuals do not have to leave their homes to receive care.” There are numerous telehealth/teletherapy offerings, so that’s definitely worth looking into.

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The Workforce

For those of you still working, you may be hearing twice the amount of “take care of your mental health” talk, because employers are harping on it. Some of this talk is out of genuine concern. I don’t mind saying that. I’m even confident in saying that. But also, this is business. According to Jason Wingard’s article, Mental Health In The Workplace: Leading In The COVID-19 Context, “Today’s leaders no longer have a choice about whether or not to advocate for mental health. They need to vocally address the issue, describing their own challenges and urging team members to seek help if they, for example, feel hyper-lonely from self-isolation or debilitatingly anxious about the spread of COVID-19.”

Our mental health—and that includes our employers, who are also people who put their pants on one leg at a time (they’re just like us!)—our capacity to use logic, reason, and common sense uninhibited by paranoia, anxiety, self-doubt, compulsive behavior, suspicion, etc., is kind of what helps to keep a business running smoothly. “In fact, the WHO estimates that every $1 invested into ‘treatment for common mental disorders’ will return $4 in improved health and productivity,” explains Wingard.

So, if you’re still working, you might be at one of those jobs where you are a touch overworked just at the moment. Maybe it seems like you can’t take a mental health day. But why does it seem like that? The CDC, the WHO, your employer (probably) are all telling you to take care of your mental health! So why does it feel like you can’t take a mental health day? According to Wingard, “In 2019, a Mental Health America survey of 10,000 workers found that 55% were afraid to take a mental health day because they thought they would be punished.”

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It kind of still feels like that, right? You’re being urged to protect your mental health but maybe the company you work for is understaffed, people are sick. Maybe layoffs are happening and if you take off, you may look expendable. It may seem like you look less than invaluable. We’re in this very uncomfortable position where we’re being told to take care of ourselves, but we’re scared that we’ll lose our livelihood if we try. That’s why I’m going to leave you all with one piece of advice:

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STOP

No, Dave, it’s not any of the song lyrics that would normally follow (although, if I had to choose, it would be to collaborate and listen). Sure, I could make false predictions all day long and whisper sweet nothings into your ear until you got a restraining order, but let’s not go there. I’m trying to earn your trust after all.

My advice is: Just stop. Take a moment to just sit down and regroup. Try letting your thoughts go on autopilot and see what comes to the forefront. If something jumps out, then maybe that’s a problem/desire/tangible thing you can focus on to start getting your thoughts in order, achieving a sense of mental balance. If nothing really pops out more than anything else, that’s okay. Sometimes just taking a moment to stop helps settle the mind. Ultimately, you need to figure out what is best for you. If taking a day off work is going to be more stressful than not, then don’t do it. But if you need a mental health day, don’t be afraid to take it. You are worth taking care of! And, please, if you or anyone you know is or may be contemplating harm to themselves or others, get help immediately.

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Revisiting Depression: Part II (Self-worth)

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Hallo, darlings. We’re back at it today with this depression topic re-visitation. On last week’s exciting episode, we covered the relationship between depression, anxiety, and anger, and how they work together in a positive feedback loop to amplify depression. Afterword, not even Dave’s corner cowering could keep us from diving into the somatic symptoms of depression and how pain and depression work together in a… well, a positive feedback loop that can amplify depression. I’m sensing a pattern here. Anyway, on this week’s emotionally unsettling conclusion, we’re finally going to address the social implications of depression and its role in self-worth. *Spoiler alert* We’re looking at another feedback loop.

The reason I wanted to look at anger and pain in relation to depression is to highlight some of the moving pieces working against the depressed. Anger and pain are both negative experiences that one needs to develop proper coping mechanisms for in order to respond appropriately. Let’s look at two different reactions to a scenario:

Scenario: Dave walks into his living room while texting a friend. Attention divided, he stubs his toe.

Reaction one (RO): In the 15 seconds after stubbing his toe:

  • Dave experiences a burst of pain
  • On the heels of that burst of pain, Dave experiences anger
  • Dave’s anger increases as he realizes his toe stubbing was a result of him not paying attention
  • Because Dave has no one to blame, he feels a bit stupid and embarrassed (regardless of the fact no one is around)
  • Dave doesn’t like to feel stupid or be embarrassed—it makes him angry
  • In the midst of the pain and anger, Dave comes to the conclusion that it’s the phone’s fault he wasn’t paying attention
  • Dave throws his phone
  • Dave begins to feel embarrassment about his behavior (still no one around)
  • Dave experiences a decrease in his sense of self-worth

Reaction two (RT): In the 15 seconds after stubbing his toe:

  • Dave experiences a burst of pain
  • On the heels of that burst of pain, Dave experiences anger
  • Having stubbed his toe many times before, Dave realizes the pain will subside quickly, so he should just breathe and ride it out
  • Dave sits on his couch and continues texting his friend, experiencing no significant changes in mood or sense of self-worth

Obviously, RT is the ideal reaction—the reasonable reaction. If you read RO and thought, “Well, that’s pretty childish,” you’re right! Spot on! Bravo, you! Individuals unable to learn and incorporate proper coping skills when it comes to negative emotions tend to react childishly to things. I think it’s important to point out here that it’s perfectly normal for anyone to have the occasional outburst. Shit happens, you might overreact, but you regroup and move on and that’s that. For someone with depression, it’s not as easy. There’s too much of a cascade effect. One stubbed toe could lead to a multiple-week-long depressive episode. Thankfully, this is an issue that can be eased with behavioral therapy and/or counseling.

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Seeking Value from Without

Before we get down to it, I just want to say that you, whoever you are reading this… You have value.

Our sense of self-worth is based on several things but can (for ease and brevity) be narrowed down to two categories: The value we place on ourselves (inside value) and the value others place on us (outside value). Ideally, there would be a balance between the two. For someone with depression, though, more stock is put into outside value. This is why some individuals with depression seek out the company of friends and family during darker times, which can be immensely helpful if the individual is in happy, healthy relationships. On the other hand, self-worth based on outside value can be crippling without those solid, uplifting relationships.

Some individuals relying on outside value, but who lack healthy relationships, tend to exhibit attention-seeking behavior. This is by no means a negative thing—although it can be. Attention seeking behavior can include: positive emotional outbursts, negative emotional outbursts, withdrawing from social situations, acting helpless, being overly helpful, being the center of conversations, and if I list any more we’re going to fall into a larger mental health topic. So, I’ll stop there. Again, these are all pretty normal behaviors when done sparingly, but it becomes problematic when someone exhibits multiple attention-seeking behaviors on a consistent basis. What’s worse is that these attention-seeking behaviors can lead to socially awkward situations, which lead to embarrassment, and… Hey! We’re back to anger! And after anger comes guilt, depression, and a lowered sense of self-worth. And, of course, how you cope (both inwardly and outwardly) with these negative emotions and situations can further devalue that sense of self-worth.

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On a Bigger Scope

**Please keep in mind that the following is a very generalized breakdown of some social implications of depression and a low sense of self-worth. While the below statements may apply to some (and in varying degrees), they won’t to others. To get more specific, we’d need to look at the different types of depression and how they affect different personality types and what’s chemical vs behavioral and on and on. You get the idea.

Building and maintaining relationships is integral to being a reasonably well-adjusted adult. How you relate to and with others helps dictate the type and quality of people who want to be around you. It also plays a major role in your career. The problem is that your sense of self-worth tends to be evident to others, whether overtly or on a more subconscious level. It’s a bit harder to like and want to be around a person who doesn’t particularly like his/herself. Because it takes more energy to be in any kind of relationship with that type of person, they’ll have fewer relationships and, likely, more contentious ones. Additionally, people with a lower sense of self-worth are more vulnerable to manipulative personalities and have a higher likelihood of ending up in long-term abusive relationships. A person relying on outside value has to be real fuckin’ careful about the company they keep, but they also have to balance how much they rely on others.

One of the biggest relationships in most people’s lives is their job. We spend a lot of time and energy there, and it’s one of the most logical places to find outside value, whether it’s from work friends, acquaintances, bosses, clients, customers, vendors, whomever. Again, it’s totally normal to desire or seek out praise and/or notice at work. But it becomes a problem when you rely too heavily on your place of work for outside value because it becomes exhausting for others. Furthermore, exhibiting attention seeking behaviors could hurt your credibility as a professional and disrupt those around you. This need for notice, the need for outside value, could end up lowering the outside value you receive, and then? Well, then you have a lowered sense of self-worth.

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It’s a Lot

Over the course of this series, we’ve barely scratched the surface of depression in all its un-glory. If you know someone with depression or are just looking to understand more, I hope this helps. For those of you dealing with depression, reach out for help when you need to. Discover ways to increase inside value. Work with a behavioral health specialist. And, please, if you or anyone you know is or may be contemplating harm to themselves or others, get help immediately.


Revisiting Depression: Part One (the Science)

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Hallo, you fantastic beauties. I haven’t written for myself—or for you—in a long while. But here we are! Together again! Now, ahead of National Condom Month, I want to talk about depression. I’ll wait while you investigate whether that’s an actual thing. The condom part, I mean, not depression.

All joking aside, I’ve been wanting to talk about depression again for a while. The problem lies in how to address something so large and weighted with so many layers. I want to talk about depression in terms of self-worth and social implications, but to get there I feel like we need to walk through the various psychosomatic effects of depression, and to get there we need to touch on the relationship between depression, anxiety, and anger …

Well, fuck, let’s give it a try! What say you, Dave? Dave? Dave, why are you cowering in the corner?! Sorry, guys, I think Dave is going to sit this one out. Let’s dive in, shall we? And, don’t worry, darlings, this will be a two-parter.

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The Fanning of the Flame
(or if you’re southern: Adding a Little Lighter Fluid)

If you pop back over to my series on Mood and Anxiety Disorders, you’ll notice that depression and anxiety often go together … But anger? I’ve only recently thought about the relationship between anger and depression, but according to Fredric N. Busch’s article, Anger and Depression, “The oversimplified concept of depression as ‘anger directed inwards’ was a commonly held belief over many years in psychiatry.” Though today anger is more often considered a symptom of depression, there is little denying some type of correlation. Busch goes on to discuss defense mechanisms as applied to the anger-depression relationship. These mechanisms include denial, projection, passive aggression, reaction formation, and identification. Since denial, projection, and (everyone’s favorite) passive aggression are pretty familiar terms, I want to cover the other two in more detail:

  • Reaction formation (as presented by Busch citing Freud): The individual denies their anger and instead increases their efforts to help others. Since the underlying issues causing anger aren’t addressed, feelings of rage intensify and can become directed inward, exacerbating depression.
  • Identification: The individual links their self-image with someone who is aggressive and has made that person or others feel disempowered, frequently triggering guilty feelings which can exacerbate depression. This mechanism can help the individual with assertiveness, coping with anger, and creating boundaries but also has a lot to do with the idea of perceived power and can lead to abusive and controlling behavior.

While these psychoanalytic mechanisms are dated, more recent studies have also shown a correlation between depression and anger, whether that anger is outwardly expressed or not. According to Depression is More Than Just Sadness: A Case of Excessive Anger and Its Management in Depression: “Previous studies have revealed that patients with anger attacks are significantly more depressed, anxious, and have ideas of hopelessness compared to patients without anger attacks, and they were more likely to meet criteria for [histrionic, narcissistic, borderline, and antisocial] personality disorders in comparison to depressed patients without anger attacks.” The relationship between depression and anger causes a sort of feedback loop wherein anger can lead to depression and depression to anger. And, ultimately—obviously—the Dark Side.

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Depression: It’s a Pain in the Ass

Fun fact: not only can depression itself be debilitating, it can also lead to major chronic health issues and be a hindrance to rehabilitation and healing. Okay, okay, so it was a not-so-fun fact. According to Depression and Other Common Mental Disorders: Global Health Estimates released by the World Health Organization (WHO) in 2017: “The consequences of [depression and anxiety] disorders in terms of lost health are huge. Depression is ranked by WHO as the single largest contributor to global disability (7.5% of all years lived with disability in 2015); anxiety disorders are ranked 6th (3.4%). Depression is also the major contributor to suicide deaths, which number close to 800,000 per year.” Spoiler alert, the situation hasn’t gotten any better.

Depression can play a role in immune, cardiovascular, and gastrointestinal health—among others. According to Depression as a Risk Factor of Organic Diseases: An International Integrative Review, “Depression often predisposes individuals to physical illness and disease.” The review assesses findings from 23 studies that consider depression in relation to various physical illnesses, including cardiovascular disease, metabolic syndrome, diabetes, Alzheimer’s, anxiety, and asthma. While the review “offers evidence that depression can be a risk factor for physical illness and disease,” even more intriguing is the study of depression-related pain.

Some studies on depression and somatic pain have shown a correlation between the two, although causation proves difficult to identify. In some cases, individuals suffering from depression may experience such issues as low back pain, jaw pain, and acid reflux. While causation is unclear (it’s kind of a “chicken or egg” situation), the Depression as a Risk Factor review states that there is “a strong association […] shown between severe depression and somatization, and the somatic effects of depression were unrelated to organic disease (Aguilar‐Navarro & Avila‐Funes, 2007; Drayer et al. 2005).” If I’m citing something citing something, is that reverse inception? Anyway, the review goes on to say that “depression and pain are independent processes that share a common mechanism that can lead to the onset of each other.” Furthermore, individuals suffering from depression tend to experience a decrease in pain tolerance and increase in origin-less pains.

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Next Week’s Titillating Adventure

Now that we’ve covered the relationship between anger and depression and the psychosomatic effects caused by the unholy trinity (just assume anxiety is a habitual lurker), we can dive into the self-worth and social implication side next week.


CBD Oil and Antidepressants for Your Pup

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This article by Jennifer was originally published on FOMO Bones.

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Depression and anxiety disorders are common illnesses that usually come about as a result of some kind of trauma. Just as humans suffer from depression, dogs do too! With all the horror stories of puppy mills and animal cruelty that flood our newsfeeds on social media every day, more people are opting to rescue a dog that has been abandoned or mistreated in some way. And while many of us absolutely advocate the popular slogan “adopt, don’t shop,” it’s surprising how many pet owners fail to realize that their new rescue pup is going to struggle to regain its trust in humans and that they will likely have abandonment issues, as well as separation anxiety and potential post-traumatic stress disorder.

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Can Dogs Get Depressed?                        

The short answer is unequivocally “yes.” A dog can absolutely experience symptoms of depression that are a result of a traumatic event, a death in the family (be it a human or their canine companion), or even a result of extreme boredom. However, depression in dogs doesn’t have to be related to abandonment or a traumatic past; many dogs that have been raised in loving families can experience depression that often stems from fear.

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What Are the Symptoms of Depression in Dogs?

There are a few telltale signs to look out for if you suspect your pup could be depressed:

  • They seem withdrawn
  • They have lower energy levels
  • They exhibit a lack of interest in activities or things that they normally enjoy
  • Their eating habits have changed
  • They have difficulty sleeping

Normally, depression related to a specific event like a death in the family can be cured with time and lots of reassurance and attention. In extreme cases, however, withdrawn depressive behavior will persist in your pup and this is when you need to do something about it.

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How to Treat Depression in Dogs

It is true that there are certain anti-depressants which have been approved for use in veterinary medicine. If a vet is convinced that your dog is depressed and that he could be at risk of harming himself, they will likely suggest an anti-depressant. However, anti-depressants work differently in dogs. They don’t act as happy pills, but rather take the edge off the anxiety and potentially harmful compulsive behaviors that put your dog at risk of injury. The downside of giving your dog anti-depressants is that many of the commonly used pharmaceuticals are accompanied by negative side effects that could be even more harmful in the long term.

Science is a wonderful thing and as more people are moving away from the use of prescription medications when possible, more natural products are emerging into the market that are not only safe but can potentially be equally as effective as antidepressants!

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Introducing CBD Oil to Treat Depression in Dogs

Depression and anxiety often go hand in hand when it comes to dogs, as depression is often manifested through anxious behavior. If left untreated, canine anxiety can lead to destructive behavior, which can be harmful if your pup is acting out by chewing and swallowing household items or obsessively licking his own paws. As with hemp oil, cannabis, medical marijuana, and other CBD products, CBD oil may be an ideal solution to effectively getting your pup’s anxiety under control so he can live a happy life free of depression and suffering.

Here are some of the ways that CBD hemp oil for dogs can effectively eliminate symptoms of anxiety and depression in your canine companion:

  • It helps regulate serotonin: Both humans and pets need high levels of serotonin in order to regulate their emotions and feel content, calm, and happy. When serotonin levels are low, your pup may be more prone to anxiety and depression
  • CBD has a calming effect: Thanks to its healing therapeutic properties, CBD will have a calming effect on your dog, which may improve his mood and allow him to sleep better
  • It stimulates appetite: One of the major signs of depression is a dramatic change in eating habits for both humans and dogs. When a dog is feeling depressed, he is likely to under eat. A few drops of CBD oil each day can help stimulate Fido’s appetite so that he can rediscover his passion for food
  • CBD oil aids sleep: A tired dog usually means a grumpy dog. CBD oil can help your dog sleep better and restore his energy levels

Aside from the above benefits of CBD, it also has the following qualities:

  • It works quickly
  • Based on clinical trials, CBD oil may also treat underlying problems like pain and nausea
  • It is 100-percent plant-based and non-toxic oil
  • There are no harmful side effects
  • It is not addictive, so you won’t have to worry about your pup having withdrawal symptoms
  • It is affordable and highly effective

So, when all the above is taken into account, it really isn’t surprising that CBD-based products are the go-to medicines for thousands of dog owners and holistic vets worldwide.

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How to Choose the Best CBD Oil for Your Dog

Good quality CBD oil will be an invaluable addition to your medicine cabinet, providing you select the right product. As one of the millions of caring pet parents out there, always make sure that the product you are buying comes from a reputable source and that it is rich in CBD vs. THC. You also want to check that the product you are buying is 100-percent organic and not chemically processed or diluted. Choosing a full spectrum oil is going to increase its efficacy and you want to administer the correct dosage to your pup depending on their weight and size. Understand that you cannot give your pup “too much” oil, but it is always better to start with smaller doses and gradually build them up until you start seeing noticeable results in your dog’s temperament. Finally, be sure that the product you decide to buy has not been extracted using chemicals, as these can be toxic and harmful to your pets.

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Author bio: Jennifer is the voice behind the FOMO Bones blog. She’s pretty sure she was a Great Dane in her past life, but her team at FOMO pegs her as more of a Labrador. Regardless of her breed, she’s a dog enthusiast with 15 years’ experience training dogs and owners.


The Doctor Is In

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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.

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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 Ipart 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.

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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.

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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.”

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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.”

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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.

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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)

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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 agreed to be interviewed. The questions for each interviewee 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.

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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 do 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 from 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 the same thing happened. I had to take my prescribed medication. I 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 in 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.

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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 would work best for me [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 and off [medication] 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 endure the hurt of losing a child.

Throughout the process of getting diagnosed and finding the right medication, many individuals must fight 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.

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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 treat 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 [the depression] 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 nutcase—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. 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 with this question 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 an 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 who 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 from depression and/or anxiety didn’t ask for either one of these illnesses. They can be debilitating for some people and life-consuming. I would like them to answer these questions:

  1. Do you enjoy getting up and going to a job every day and socializing with people?
  2. Do you like making money? Could you survive on $500-1,200 a month?
  3. Do you like going to the doctor and being reminded to get medications and when to take them?
  4. 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?
  5. Do you like to be reminded to shower daily, to accomplish one task a day?

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Mood and Anxiety Disorders: Part One (the Science)

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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 is completely concrete here. Every day we are learning more about the brain. That said, the clinical studies included in this post reflect the most in-depth researched and medically accepted causes for depression and anxiety.

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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 throw 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 by a secondary problem.

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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 (HT) and Beck’s Theory (BT) further backs 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: “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 the 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.

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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!

Why Understanding Dreams Matters

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What’s the big deal with dreams, and why is it so important we figure it out? Well, because when we dream, our brain is doing something. So, what if what it’s doing is helping or hurting us? The science behind dreaming—especially the physiology and how it relates to health—is a subject we just don’t know a whole lot about.

The topic of dreams has been a hot one for so many years you can trace it back to Ancient Greece, where they thought dreams told the future. The beliefs about dreams are numerous and range from ridiculous to plausible, including:

  • Dreams are a manifestation of the unconscious (show of hands, Freudians)
  • Dreams stimulate problem solving
  • Dreams help process negative emotions
  • Dreams are the collecting/discarding of brain trash (that’s very unjustly put, I admit)
  • Dreams consolidate short term memories to long-term memory
  • Dreams are a byproduct of neural impulses

Etc., etc., etc.

You see where I’m going with this? So, who’s right? Put your hand down, Dave, you don’t know the answer. There is no answer. Part of the reason for that is because it’s brain-stuff. I feel like I shouldn’t have to say more, but I will. Of all the sciences, neuroscience is probably the one top ones where the least amount of answers have been discovered. And that’s not a slam on neuroscience—for which I have a deep love—it’s a testament to the human brain.

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Why Memory Consolidation is so Appealing

The theory of dreams being a byproduct of memory consolidation/processing makes very good sense to me, despite the nay-sayers. Part of the reason I’m so attached to this theory is because I can see it working. Take the elements in this dream I had, for instance:

  • I was fresh out of college and the only job I could get was as a manager of a local supermarket
  • I had crippling student loans
  • I had just come on shift when there was a zombie outbreak, so I had to lead my employees to safety
  • I had to run to my car to retrieve my revolver

That dream was both awesome and hilarious. It’s one of my favorites. I am also planning to write a book about it, so hands off my dream! Now, compare the dream elements with my reality:

  • When I was fresh out of college, I worked a retail job where I was in management
  • I have slightly less-than-crippling, although no less daunting, student loans
  • I had been marathon-watching Ash vs. The Evil Dead the day/evening before the dream
  • I keep a pistol in my car (this is a judgement-free zone)

This ability to connect dream elements with real world elements gives me the proof I need. But, you’re not me, so I don’t know if the same holds true for you.

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Why All the Hubbub About Dreams?

Many people still believe that dreams mean something, whether it’s the expression of the unconscious mind or symbolism of what one might be stressing over, looking forward to, etc. And, if you fall into that category, that’s fine. Remember, judgement-free zone.

Learning about dreams—both causes and the result of REM sleep deprivation—can also lead to additional information on such mental health issues as depression, migraines, and the development of mental disorders. I want to note here that, in some cases, REM sleep deprivation has been shown to improve the state of depressive patients.

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No matter what you believe dreams to be or not be, mean, or not mean, I’d like to think that we can all agree on this: The more we discover about the nature, physiology, and effects of dreaming, the more ammunition we may have against some types of mental health issues. And that, my friends, would be a beautiful thing indeed.