Category Archives: Opinions

Depression: The Silent Epidemic

Mohamad Idriss

Wayne State University, Detroit, MI


“The opposite of depression is not happiness, but vitality.”  -Andrew Solomon

The Idea

Depression is often misunderstood, especially by those who have never experienced it themselves or through someone close to them. It has even come to be used colloquially, to mean that you’re simply having a bad day, but depression isn’t an emotion that comes and goes haphazardly. It is a deep state of self that may envelope everyday life and make the normal seem horrible and the bad seem catastrophic. With it come physical weakness, social reclusiveness, and above all, an inability to partake in the pleasures of life. Many may think that it is not an issue that they will ever have to deal with, but the statistics indicate otherwise. Approximately 1 in 5 people will experience a depressive episode at some point in their lifetime. This is why it is important that there be general knowledge on what depression is and practical ways to talk about, cope and work through this silent epidemic.

Melencolia

Melencolia

Defining Depression

First and foremost, it is important to seek out professional help for you or anyone close to you that may be going through depression. The DSM (Diagnostics Statistics Manual), the manual that mental health professionals use to diagnose patients, splits depression in two main ways. One form is called major depression and is marked by being sad or unhappy for at least two weeks.  With major depression, you lose interest in things that used to interest you and have feelings of hopelessness, worthlessness and helplessness. The other form is dysthymia which is marked by a slightly milder depression that lasts for longer periods, usually 2 year or longer.  Bipolar disorder is also listed in the DSM and is marked by recurring periods of extremely elevated followed by extremely depressive moods. All 3 illnesses have symptoms including reduced self-esteem, loss of appetite, disturbed sleep, thoughts of death or suicide and more. These symptoms come in different combinations and different intensities. It is important to remember that negative moods many times make sense. When you experience a loss or a very stressful event in life it makes sense to have lowered moods. It is when the sadness or depression is disproportional to the life event that it becomes a problem.  At the end of this article will be resources that may help you get professional attention if needed and other resources that may be helpful.

The Myth

Many a myth surrounds the idea of depression. Some think that is all mental, while others uphold that it is simply chemical. Say someone has a good job, has great habits and is surrounded by loved ones. When such a person experiences depression, many will tell that person to snap out of it. On the other hand, there are those people with many stressors, such as having a hard time at work, losing a loved one or having money problems, yet they are able to carry on with their lives unhindered by depression. These scenarios give confusion to both arguments and are an indicator as to why current consensus in the science world is that it is a mix of both.  Even if someone doesn’t seem to have any reason to be depressed, it is not good practice to suggest that a person simply shrug it off. This leads to the stigma of mental illness and is why so many try and hide their mental ailments even when it becomes extreme in nature. Whatever the reason, and even if there is no reason you can point out, depression is detrimental to a healthy lifestyle and must be combated. This is also a reason amongst other reasons that many deplore the idea of anti-depressants to help them get better. Research shows that only 29% of people with depression ever seek out mental health treatment, even though 80% of patients with depression will improve with treatment. Depression is peculiar in that its symptoms bring about more depression in a catch-22 style. Eventually, the depression gets too strong and becomes a beast of its own that is difficult to reverse, especially without outside help. This is why it is important to seek out help when one is well enough.

The Prescriptions

Here I would like to focus on practical methods for dealing with depression and also ways to lead a life that would help deter depression, if you have none. Firstly it is important that you understand what depression is and from there you will be able to help yourself and those around you get care if needed. This will also allow everyone to have a common ground when the subject is brought up.

Practical Tips

First and foremost it is important to have an open line of communication with friends and family. Being open to those close to you is important in maintaining a healthy lifestyle.  Connectedness with those around you gives way for empathy, sympathy and understanding – which in themselves help reduce suffering.

A great lifestyle choice that is exceedingly researched is exercise. The research is so strong on the benefits of exercise in combatting depression and anxiety that many doctors say the best prescription for depression is regular exercise. Regular exercise helps reduce stress, increase self-esteem, improve sleep, ward off anxiety and much more.

An active routine is also important. Humans do not like to live sedentary lives. A sense of meaning and an active routine is important to self-esteem, and the feeling of progress keeps us going. Making progress in life, having healthy habits and having good interpersonal relationships with those close to you are important to having a fulfilling life.  Some of the happiest people are those whose passions are engrained into their daily life.

Nowadays it is important to have positive, realistic expectations of yourself. With the advent of social media, it is easy to lose your self-esteem to the façade of perfection that we all post online. Learning to live with realistic expectations is an increasingly healthy skill to maintain.

“Neurons that fire together wire together” is a phrase attributed to neuropsychologist Donald Hebb. This is good concept to understand when dealing with depression. It is the idea that sensations, thoughts and experiences, when repeated over and over, embed themselves into our neural networks. It becomes more difficult overtime to rid yourself of negative ideas especially. It is good to remember that feeling better and rewiring your brain in a more positive direction will take time and effort – but it does not mean that it is impossible.

Of course, there are a countless more ways to deal with depression and keep it away. We should develop many methods of dealing with negative moods. This gathered toolbox will help in coping with all types of circumstances and stressors.

The Silver Lining

Although the effects of depression may be counterproductive, and at times even catastrophic, we should remember that without depression, it would be difficult to gauge sublime happiness and love. A few positives do come with depression, though they may be truly difficult to see. Namely, among them are deep emotion, obsession and an acute awareness of the self. At different levels of depression and low mood, these become possible. Deep emotion can be troubling at times, but it can also give rise to important contemplations on your life and close ones.  Obsession sometimes comes with depression. Obsession, though sometimes a negative trait, may be utilized to become a positive one. Obsession in your passion may drive you to create something amazing or to discover something new. Lastly, acute self-awareness (though with depression self-awareness is many times misleading) can give way to much self-discovery and personal growth. Keeping these in mind can help one work through and at times accept their current predicament. One can learn to welcome the pain and even learn from it.

Conclusion

Depression does not discriminate and so we should all be vigilant and put care and effort into our mental health. It is important to be honest with yourself and go to trusted professionals that may be able to help with your situation.  Any step in combatting this illness within yourself is a step in the right direction. It is important to remember that our brains and psyches are complex and malleable, and that there is no one- size-fits-all when it comes to treatment and prevention of depression.  Above all else, we must learn to feel more in control and realize that biology does not have to be destiny. We all deserve to be happy, but more importantly we all deserve to live vibrant lives of productivity and vitality.

References:

http://www.nimh.nih.gov/health/statistics/index.shtml

http://www.guideline.gov/content.aspx?id=24158

http://www.apa.org/topics/depress/support.aspx

https://www.nimh.nih.gov/health/topics/depression/index.shtml


Community Resources:

Access Behavioral Health Department

1-313-945-8148

6451 Schaefer Rd, Dearborn, MI 48126

Detroit Wayne Mental Health Authority

640 Temple.

Detroit, MI 48201

Tel: (313) 833-2500

TTY: (800) 630-1044

Michigan Department of Human Health

Capitol View Building

201 Townsend Street

Lansing, Michigan 48913

517-373-3740

National Suicide Prevention Lifeline

1 (800) 273-8255

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Leadership

By Oula Kassir, MPH

Michigan State University School of Public Health, East Lansing, MI


 Civil Rights leader Martin Luther King Jr. was a man who offered an inclusive vision for racial equality. He healed the division of society and built communities. He is vividly remembered as a great leader who believed that there are laws created by higher authority and others created by man and justice will not be served till both laws are even.

 MLK made me realize that leadership could be interpreted and approached differently. I came to understand that leadership involves “inside out” awareness while individuals often think from the “outside in” aspect. In other words, individuals tend to know “what” they are doing but very few know or understand the“why” in relation to the purpose. Leaders, however, begin by understanding “why” and move toward what they need to do to fulfill their purpose. The civil right movement helped MLK bring his cause of life.

800px-Martin_Luther_King_Jr_NYWTSThose who begin by explaining “why” and the ones that show the possibilities of turning visions into accomplishments by changing the way they look at the world and their place in it are the ones who inspire others. Those individuals have recognizable qualities of character and mind of a great leader that is not necessarily earned by a degree or associated with any sources. In fact, they are passion-driven, confident and dedicated. Also, they have values based on honesty, empathy and humbleness. Leaders need to develop other leaders and understand that leadership is an ongoing process that will never stop (Goldsmith & Goldsmith, n.d.). Great leaders understand the difference between managing and coaching others. They understand that they’re a part of a whole and they need to work with others toward a common goal. These qualities distinguish leaders from those who lead and thus it is important to understand the difference. Not all leaders use their powers and position to have a positive influence on the society.

The most rare commodity is leadership without ego. Empathy is critical for leader development to be able to recognize the concerns people have. Growing up in a country where adequate health care is very limited helped me understand how individuals in the same position feel. This is a very significant skill for public health professionals considering that it allows them to better access community needs.

Various goals could be achieved by the ability of working in diverse groups. Coming from a different culture aids me in becoming more open-minded towards others with different backgrounds as well. This skill will help me when working abroad to develop better healthcare resources.

My passion and thirst for knowledge as well as self-improvement is endless. I believe leading others requires reflection and the ability to set goals, evaluate, practice, support, and challenge. I would like to improve and expand my knowledge base on certain areas that interest me in public health field including environmental health and administration. I speak two different languages and would like to learn more foreign languages since it will help me communicate with individuals from diverse countries. My future self would focus on building bonds and relationships with individuals as well as conventions and being able to be an inspiring victory for individuals around the world.

Reference:

Goldsmith, M., & Goldsmith, K. (n.d.). Helping People Achieve Their Goals. Retrieved from http://www.marshallgoldsmithlibrary.com/cim/articles_display.php?aid=282

Novick, L. F., Shi, L., & Johnson, J. A. (2014). Novick & Morrow’s public health administration: Principles for population-based management. Burlington, MA: Jones & Bartlett Learning.

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Humor: Letterman and Thoreau

By Shady S. Shebak, MD

Psychiatry Resident, Virginia Tech Carilion School of Medicine, Roanoke VA


David Letterman

David Letterman

It wasn’t until my college years that I read more about his persona, his feuds, and his special relationship with the Dean of late night talk shows, Johnny Carson. After reading more about him, I noticed that the person we saw every night was the real David Letterman. In today’s world of facades, there is something uncomfortable about seeing realness, and yet, this was where Letterman was masterful, and probably why he lost the ratings battle to the talented, but more comfortable entertainer, Jay Leno. His realness is probably why he got the hype from fellow comedians, bidding him a farewell, and is probably why his fans have been so loyal to him. Ratings really didn’t matter as much as doing his job the way he wanted to do it.

What is it that makes today’s world more interested in the “fake”? Today’s society is much more interested in compartmentalized human beings, rather than the full human being. An entertainer is an entertainer when at work, and that is the depth that people expect. A physician is a physician when at work, and that is the depth that people expect. The teacher is a teacher when at work, and that is the depth that people expect. It’s an unfortunate flow of events that led us here, and some people worked tiresly for this very situation we find ourselves involved in and defending. Not many people like the current situation of facades and compartmentalized living, but we defend it. How do we defend it? We come up with terms like “professionalism” and “barriers” and “boundaries” and “evidence based” and “home life versus work life”. The list is endless and yet the same, it seeks to keep us from realizing our full potential in all the situations that we face, day in and day out. We take on personas instead of taking on a full on personality.

“I wanted to live deep and suck out all the marrow of life– Thoreau

It’s a fake way of living, and it sucks the marrow out of life: the marrow that we are supposed to be sucking out of life, and leaves us with a piece of rock-hard calcium, with no flavor, and rigid boundaries. We have and continue to trap ourselves in the monotony of being fake, and this fakeness has now overtaken the realness of human life. Let me provide an example. There was a time when teachers would teach their pupils real lessons, and would instill in them ideas to be agreed upon or disagreed upon, and they commanded a level of reverence. Today, teachers are being forced to teach to various exams, there is little room for bonding with their students, and if they do form a close connection with their pupils, the professional police come in and remind the teacher of their “professional boundaries”. Mentorship is all but gone, as teaching has become a job of technicians rather than human beings invested in the passage of knowledge to other human beings.

Henry David Thoreau

Henry David Thoreau

Anyways, I went off on a tangent, but that is why I hold Letterman and the likes of Letterman in high regard. It’s because he did not become fake, and used his own honest and at times uncomfortable demeanor to deliver late night laughs, and helped launch the careers of fellow comedians in a real and effective way. He treasured the mentorship that he received from Carson, he cherished the physicians who operated on his heart in a very heartfelt manner, on his show, and he did not allow comedy and his comedian profession take away from the rest of his persona.

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Binaural Beats: Sound Drugs?

By Shady S. Shebak, MD

Psychiatry Resident, Virginia Tech Carilion School of Medicine, Roanoke VA


Binaural beats are perceived when two auditory stimuli of slightly different frequency are presented to each ear. The difference between these two frequencies would be the binaural beat.1 It is a complicated and inconclusive topic, but a rather interesting one. Heinrich Wilhelm Dove discovered the phenomenon in 1839, and since then interest into this phenomenon has continued and expanded. Conducting a simple search online, one can find that binaural beats are being used by subjects to achieve perceived changes of consciousness, relaxation, and entertainment. I wish to bring this phenomenon to the attention of clinicians and researchers so that we may get a better understanding about the therapeutic benefit of using binaural beats, as well as potential risks.

Heinrich Wilhelm Dove

Heinrich Wilhelm Dove

In a study conducted by Brady, et al.,2 exposure to binaural beats was shown to increase hypnotic susceptibility in participants with low hypnotizability, and there was an increase in percent theta waves in 5 of the 6 participants. This study has obvious limitations due to sample size, but it is a promising pilot study for future research. A follow-up study3 was done, and could not replicate the initial study’s results, but showed that patients with moderate hypnotizability showed an increase in hypnotizability after being exposed to binaural beats. From the above studies, it is possible to hypothesize that binaural beats are mind altering, although it is premature to make any conclusive remarks. Another study1 showed an increase in depressive symptoms as well as poorer immediate recall after exposure to binaural beats. There is some evidence to suggest that binaural beats may have a role in decreasing anxiety.4

I wonder how many people in the population are using binaural beats for meditative practices or as a substitute for mind altering substances. It is of further interest as to how and if binaural beats cause alteration of consciousness, and how much the dopamine pathway is involved. Furthermore, could binaural beats become addictive? Could they be a real alternative therapeutic agent? These are questions to be considered for further review.

Peer Reviewed References:

  1. Wahbeh H, Calabrese C, Zwickey H, Zajdel D. Binaural beat technology in humans: a pilot study to assess neuropscyhologic, physiologic, and electroencephalographic effects. The Journal of Alternative and Complementary Medicine. 2007;13(2):199-209.
  2. Brady B, Stevens L. Binaural-beat induced theta EEG activity and hypnotic susceptibility. American Journal of Clinical Hypnosis. 2000;43(1):53-69.
  3. Stevens L, Haga Z, Queen Z, et al. Binaural beat induced theta EEG activity and hypnotic susceptibility: contradictory results and technical considerations. American Journal of Clinical Hypnosis. 2003;45(4):295-309.
  4. Wahbeh H, Calabrese C, Zwickey H. Binaural beat technology in humans: a pilot study to assess psychologic and physiologic effects. The Journal of Alternative and Complementary Medicine. 2007;13(1):25-32.

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The Problem With Education: It’s Not Just the Schools

By David Low, MD, PhD1 and Barbara J. Low, Dr. PH2

1Professor Emeritus, University of Texas School of Public Health, Houston TX

2Adjunct Faculty, Athabasca University, Alberta, Canada


Tain’t what a man don’t know that makes him ignorant. It’s what he knows that ain’t so.” Samuel Clemens

Samuel L. Clemens (Mark Twain)

Samuel L. Clemens (Mark Twain)

What do we know about education that ain’t so? A partial listing would include the following bits of conventional but misguided wisdom:

  • Across the nation, schools are failing to teach our children effectively.
  • They fail because teachers aren’t accountable, don’t administer sufficiently rigorous curricula, won’t do enough testing or won’t maintain discipline in the classroom.
  • American children don’t do nearly as well as their counterparts in other developed countries on tests of reading, math, and science.
  • Education begins in kindergarten.

Whatever it is, it is important that we get the education problem right. Perhaps most importantly for individuals, education, health, and life expectancy are very closely linked–the longer you stay in school, the longer you are likely to live. For the nation, information is the currency of this age, and functional literacy is the critical element for understanding and using information effectively. Our own research work and that of many others clearly shows that while the future of our country may well be at risk in the new information age, it isn’t just because of what is or is not happening in American classrooms. Out of ignorance or unwillingness to face hard truths, we may be on our way to making some very expensive mistakes by trying to fix the education problem in the wrong place in the wrong way.

The real problems confronting education and educators are a consequence of the catenary chain of events that follows from the dramatic differences in people’s social and economic circumstances across this vast and varied country. Test scores that typically are reported as national averages obscure significant regional differences in student achievement. In reality students in some American States perform on a level with the best in the world, while some perform at a level below almost any other developed country. A better understanding of why these differences exist, and persist, can point the way to effective and lasting interventions.

We believe that the “problem” with education is not just that schools aren’t doing their job. Clearly many are doing a superb job. If some can do it, they all can do it; at least if they can work with the same range of student abilities and available teaching resources.   But not all children come to school with the same advantages. The differences between children that develop as they grow up in relatively enriched or impoverished circumstances, lead to vastly different levels of personal mastery, attitudes toward success, beliefs about education, and abilities to learn before they ever get to school. Inequalities in these personal “spiritual” resources, in Nobel Laureate Robert Fogel’s terms, are as important as material ones. Our greatest concern should be for the inevitable consequences of not addressing the conditions that lead to these differences.

What are those consequences? There are many, but the most costly in both human and economic terms is perpetuation of disadvantage. Along with the loss of social capital, we pay a price in human suffering and the highest health care costs in the world. A great deal of research in the USA and elsewhere has shown that health status in a population follows a gradient that is a function of social position. Those on top not only enjoy higher incomes, they are also healthier than those who are less fortunate. The greater the differences in economic status, the greater the differences in health status. As the economic gulf widens, the health gulf widens. Ominously, income differences between the most well-off and the least well-off in America are getting wider, and it is this deepening and hardening of social stratification that poses the real threat to America’s future. (Low & Low, 2006: http://journalofethics.ama-assn.org/2006/11/pfor1-0611.html)

Because of strong evidence linking educational attainment to social position and life’s chances generally, we are working to identify the personal and social determinants of educational success and health among children in America. Looking at personal, parental, social/cultural, economic, and school-specific factors, we are asking the questions “Which American children will succeed,” and “How can we ensure that all children have a fair chance to succeed in school, and in life?”

Using data from state and district levels across the entire United States and with standardized math and reading test scores of 4th– and 8th-grade students as our initial measure of “success,” the most striking finding is the geographic distribution of scores. The average scores of children from schools in states north of the Mason-Dixon line are all at or above the national average. In comparison to other countries, the scores from Iowa, Minnesota, and a few other northern-tier states are consistently on par with the best in the developed world. It is a very different story for children going to school below the Mason-Dixon line. With the exceptions of North Carolina and Virginia, their average scores are all below the national average. Mississippi and Louisiana are very much below, on par with the worst performing countries in the OECD. California and Hawaii also do poorly, but native language and culture appear to be the primary reasons for their performance on standardized tests. (NAEP, 2014: http://nces.ed.gov/nationsreportcard/about/assessmentsched.aspx)

The strongest statistical correlations between math and reading test scores are with personal factors specific to the students themselves, their parents and families, and resources in their homes. Teachers’ experience, and personal and regional economic conditions are also important factors. It is clear that an exclusive focus on schools will miss most of the critical factors that lead to success for children, both in school and in life. The case of Washington, D.C., where they spend nearly twice as much per student as in Montana, for example, with significantly worse outcomes, shows that money alone, even large amounts of it, is not the answer either. Learning and education begin at birth, not in kindergarten. Even more importantly, a child’s early life experiences are critical factors for brain development. Both positive and negative experiences have very long-lasting effects.

What is really needed is a comprehensive and integrated model for optimal early childhood development, health, and education that can be applied in every community in America, securely supported by federal, state, and local resources–something like a strengthened and expanded version of Georgia’s Bright From The Start programs. (Bright From the Start, Georgia Department of Early Care and Learning: http://decal.ga.gov/#1)   We need to think of our common responsibilities for the education of our children in these terms and begin to create policies that reflect such understanding. Our children deserve it, and our country needs it.   

Peer-Reviewed Reference:

Low, B. J., & Low, M. D. (2006). Education and education policy as social determinants of health. American Medical Association Virtual Mentor, Journal of Ethics, 8(11), 756-761. Retrieved from http://journalofethics.ama-assn.org/2006/11/pfor1-0611.html

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