Brain Blogger » Chadwick Royal, PhD, NCC, LPC, ACS

Anti-Aging – The Fountain of Youth – Part I

Chadwick Royal, PhD, NCC, LPC, ACS — Thu, 12 Feb 2009 14:47:50 +0000

I am fascinated by stories of 104-year-old people who wake up every morning, eat a half-a-pound of pork, smoke a pack of unfiltered cigarettes, and drink a few fingers of vodka. I tend to feel a little better about the caloric-rich breakfast that I cook every Saturday morning for my family. On the other hand, I dislike to hear stories about 42-year-olds who run 3 miles a day and die from sudden and massive heart attacks. Or there are the athletes who suddenly collapse during a game. They have spent years training, exercising, and performing, but there is a hidden physical ailment that claims their life in the end. I’m frightened by the reality that anything is possible, and no one is invincible.

Despite our best efforts, we can’t escape genetics. Perhaps the best evidence of such is the story of the “Jim Twins”, two twin males separated at birth in rural Ohio. They grew up a short distance from each other, in separate households, not knowing of each other presence. However, there were uncanny similarities in their lives. Despite having the same name, James, they both gave their first children the same name (one was James Alan, the other James Allen). They married women with the same name (Lindas), divorced, and remarried women of the same name again (Bettys). They both had dogs named “Toy”, they both smoked the same brand of cigarettes, and drank the same brand of beer. They held similar occupations, enjoyed the same hobbies, and vacationed in the same area of Florida each summer. The “Jim Twins”, once reunited, were part of Dr. Thomas Bouchard’s twin work at the University of Minnesota.

Twins studies naturally lend themselves to a nature versus nurture debate. Is a person a summary of their genetics, or are they a product of their environment? In considering the Jim Twins, the similarities are so uncanny, that it seems possible to assume that our lives are predetermined when we are born. Some factors might explain some of the coincidences seen (e.g., popularity of specific names used during the time in which they lived). What we don’t take into account are the factors that might that have detracted from the similarities… the “what if” factors. What if one of the Jims grew up in poverty? What if one of the Jims had grown up in New York City, as opposed to rural Ohio? What if one of the Jims had been abused as a child? What if one of the JIms had an alcoholic parent? What if, as a child, one of the Jims had a parent to die? How would any of these environmental factors impacted the development of one of the Jims?

It is likely that the two Jims grew up in very similar households, and the environments would not have been significantly different. Environmental similarities would make it likely for there to be more individual similarities. Likewise, with environmental differences, there would likely have been somewhat different outcomes. This is true for our physical health as well. We might have some predetermined factors and qualities with respect to our genetics, but our environment is likely to promote different outcomes.

We do have some control over our environment. My personal opinion of the 104-year-old pork-eating, cigarette-smoking, drinker: They are likely to feel much better (physically and mentally) if they would exercise a high-degree of moderation.

Part II of this series will examine ways to optimize your mental as well as your physical health.

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Therapy and Medication – Where’s the Breaking News?

Chadwick Royal, PhD, NCC, LPC, ACS — Tue, 20 Jan 2009 13:37:25 +0000

The National Institute of Mental Health recently cited a study published in the December 2008 issue of the Journal of the American Academy of Child and Adolescent Psychiatry. The study was cited as providing evidence that supports the idea that adolescents with major depressive disorder (i.e., depression) are less likely to relapse after treatment if they receive cognitive behavioral therapy in conjunction with psychotropic medication.

I have to admit that this was not entirely shocking news to me, but I was slightly surprised to find the topic highlighted by NIMH as a “Science Update.” Granted, I don’t regularly read any psychiatric journals. I am a counselor by training, and typically receive only the professional publications that come with my professional association memberships. I suppose that I had just assumed that this was a well-researched topic. Obviously, the publications that I read are written from a different perspective. If the subject is featured, it is most likely written with the idea that therapy is inherently beneficial.

I teach in a counselor training program, and I would estimate that the majority of interventions that we discuss are primarily cognitive-behavioral in nature. Our counselors-in-training receive education is many different theoretical models, but cognitive-behavioral theory is the primary focus with respect to development of specific counseling skills.

So what is the “discovery” here? The connection with the treatment of adolescents?

The majority of my time spent in the field has been spent counseling adolescents. I’ve worked in conjunction with multiple psychiatrists over the years, and for the most part we have usually followed a similar protocol. All adolescents in treatment received counseling services. If warranted, the adolescent was seen by the psychiatrist for a medication evaluation (and management follow-up, if any medications were prescribed). One psychiatrist who I worked with, in particular, would cancel an appointment with the adolescent/family if they failed to keep their appointments with me (as their therapist).

My assumption here is that most practitioners and clients have had similar experiences. Therapy plus medication is more successful than medication alone. If that is true, why is this considered breaking news?

References

Kennard BD, Emslie GJ, Mayes TL, Nightingale-Teresi J, Nakonezny PA, Hughes JL, Jones JM, Tao R, Stewart SM, Jarrett RB (2008). Cognitive-behavioral therapy to prevent relapse in pediatric responders to pharmacotherapy for major depressive disorder J Am Acad Child Adolesc Psychiatry, 47 (12), 1395-1404 PMID: 18978634

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Work and Mental Health

Chadwick Royal, PhD, NCC, LPC, ACS — Fri, 02 Jan 2009 12:59:51 +0000

“John” was referred to me for counseling services by his primary physician. John’s primary complaint: Panic attacks one to two times per day. I conducted a standard intake interview, asking him about all areas of his life. He had never experienced any panic attacks until one night a few months prior to his appointment with me. Like many people who experience their first panic attack, he spent an evening in the local emergency room being checked for a possible heart attack.

Since his first attack, the attacks became more frequent and more severe. “Now,” he said, “I get a panic attack because I’m afraid I’m going to have (another) panic attack.” This is a common experience.

As a practitioner, nothing can replace obtaining a thorough history, screening, and intake. I discovered that he had experienced some degree of anxiety throughout his life. Generally speaking, he was a worrier. But there was more to it than perhaps being biologically predisposed to panic attacks. At the time of the appointment, he was experiencing some difficulties in his relationship with his wife. She was very critical of the fact that he was currently not working. They had several children between the two of them, and money was tight.

There were multiple options for my work with him. We discussed cognitive behavioral strategies to address relaxation, communication strategies that he could use with his wife, and — what turned out to be the most important element — career counseling.

After he revealed that a job, any job, would drastically improve his life, he was on his way to feeling better. It seemed his first attack happened not too long after he lost his previous job. Now the attacks were consuming his life. Having a job equaled less stress over finances, less conflict with his wife, less worry over providing for his children, and less time to worry about worrying.

As a counselor, there is not a clear separation for me between “career counseling” and “personal counseling”. I can’t really conduct career counseling without covering personal issues. Even when I see someone for personal counseling, they quite often discuss work to some extent. Having a job we dislike makes us miserable in other parts of our life. Our work affects our mental health, and our mental health affects our work.

People wrap so much of their identity in their work. Let me illustrate, what is one of the first things people say when meeting someone for the first time… “So… what do you do for a living?”

Quite often, work (paid or unpaid) is how we identify ourselves to others. We develop a sense of who we are based on what we do and what we have accomplished (some more than others). Unemployment takes away part of who we are, and how we feel about ourselves.

It makes sense that work is important to our health and has such an impact on our life. For most full-time workers, the majority of time awake each day is spent at work or completing work-related tasks at home.

How does work (or the absence of work) affect you?

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Suicide Rates Could Rise

Chadwick Royal, PhD, NCC, LPC, ACS — Fri, 19 Dec 2008 14:33:48 +0000

“The sky is falling… the sky is falling!” Well, not exactly… but it certainly might feel like it given current economic circumstances. We are experiencing a financial period that has been likened only to the depression-era of the 1920s and 1930s — but still, a time like no other in history.

As a mental health practitioner, I’ve always been aware of the need to make some type of determination of whether or not clients might be a danger to themselves. There are various warning factors to consider — also considered “red flags” (e.g., feelings of hopelessness, depressed mood, thoughts of suicide, and experience of recent losses, just to name a few).

Given the current financial circumstances of many, exactly how many people would meet the criteria for me to start worrying about their safety? People have lost jobs, homes, and their life savings. Many are feeling the secondary, or tertiary, effects of our economy.

Suicide rates overall tend to reveal social problems. Individuals who attempt suicide can and do have multiple reasons for their behavior, but the impact of ecological factors on suicide and self-harm is undeniable. There is a connection between people and their environment. If the environment is in chaos, there is great potential for creating chaos within individuals. Insulating characteristics (social connectedness, for example) can help – but perhaps don’t guarantee safety, depending on the nature of the chaos-producing events.

Yang found that past suicide rates (between 1940 and 1984) did not increase during previous economic booms or busts, but there were social factors that were found as significant variables. Unemployment and divorce each had a relationship with higher suicide rates.

With unemployment on the rise, home foreclosures at an all time-high (and predicted to increase), the financial strains on individuals and families are likely to worsen. All of these factors are a recipe for disaster.

It is likely that the suicide rate will increase, at least over the next year. Although this time period is similar to the early twentieth century depression, it is not identical. The resources we possess make it unique. We cannot predict what or when the outcome will be — but we can be hopeful. In the meantime, let’s try to keep the chaos at a minimum. Be mindful of those who possess crucial warning signs relevant to our time period: unemployment, relationship problems, financial difficulties, housing loss, and substance abuse.

Even if the sky is falling, Chicken Little doesn’t help.

References

M WRAY, M MILLER, J GURVEY, J CARROLL, I KAWACHI (2008). Leaving Las Vegas: Exposure to Las Vegas and risk of suicide Social Science & Medicine, 67 (11), 1882-1888 DOI: 10.1016/j.socscimed.2008.09.002

Yang, B. (2006). The economy and suicide. American Journal of Economics and Society, 51, 87-99.

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