Hello, 2013!

As 2012 draws to a close, I hope you can all look back on the year and see how far you've come. Certainly, at times, there have been road blocks, detours, and dead ends, supposed failures and backward steps. But there have been victories as well, and I want you to focus on those for a moment, however small those victories may seem to you. Think about what aided you in your success. Was it persistence? Clarity of mind? Utilizing your strengths instead of your limitations? Whatever most attributed to your well being in the past year, make sure to carry it over to 2013. Leave behind the self-loathing and criticism. Plan to spend more time with those who lift you up, and less time (or no time, if possible) with those who trample on your self-esteem and emotions. Figure out the top 3-5 priorities you want to set for the new year, and make sure your own mental health is at the top. You owe it to yourself to take care of your emotional needs, so that you can more successfully tackle everything else in your life. It is not selfish. It is vital! Don't let anyone convince you otherwise.

Happy New Year! I hope it's the best one yet!

An In-Depth Look at Eating Disorders

An eating disorder is an illness that causes serious disturbances to your everyday diet, such as eating extremely small amounts of food or severely overeating. A person with an eating disorder may have started out just eating smaller or larger amounts of food, but at some point, the urge to eat less or more spiraled out of control. Severe distress or concern about body weight or shape may also characterize an eating disorder.

Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood or later in life.^1,2 Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Eating disorders affect both men and women. For the latest statistics on eating disorders, see the NIMH website.

It is unknown how many adults and children suffer with other serious, significant eating disorders, including one category of eating disorders called eating disorders not otherwise specified (EDNOS). EDNOS includes eating disorders that do not meet the criteria for anorexia or bulimia nervosa. Binge-eating disorder is a type of eating disorder called EDNOS.³ EDNOS is the most common diagnosis among people who seek treatment.⁴

Eating disorders are real, treatable medical illnesses. They frequently coexist with other illnesses such as depression, substance abuse, or anxiety disorders. Other symptoms, described in the next section can become life-threatening if a person does not receive treatment. People with anorexia nervosa are 18 times more likely to die early compared with people of similar age in the general population.⁵

The Different Types of Eating Disorders

Anorexia Nervosa

 

Anorexia nervosa is characterized by:

• Extreme thinness (emaciation)
• A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
• Intense fear of gaining weight
• Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight
• Lack of menstruation among girls and women
• Extremely restricted eating.

Many people with anorexia nervosa see themselves as overweight, even when they are clearly underweight. Eating, food, and weight control become obsessions. People with anorexia nervosa typically weigh themselves repeatedly, portion food carefully, and eat very small quantities of only certain foods. Some people with anorexia nervosa may also engage in binge-eating followed by extreme dieting, excessive exercise, self-induced vomiting, and/or misuse of laxatives, diuretics, or enemas.

Some who have anorexia nervosa recover with treatment after only one episode. Others get well but have relapses. Still others have a more chronic, or long-lasting, form of anorexia nervosa, in which their health declines as they battle the illness.

Other symptoms may develop over time, including:^6,7

• Thinning of the bones (osteopenia or osteoporosis)
• Brittle hair and nails
• Dry and yellowish skin
• Growth of fine hair all over the body (lanugo)
• Mild anemia and muscle wasting and weakness
• Severe constipation
• Low blood pressure, slowed breathing and pulse
• Damage to the structure and function of the heart
• Brain damage
• Multiorgan failure
• Drop in internal body temperature, causing a person to feel cold all the time
• Lethargy, sluggishness, or feeling tired all the time
• Infertility.

Bulimia Nervosa

 

Bulimia nervosa is characterized by recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors.

Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is considered a healthy or normal weight, while some are slightly overweight. But like people with anorexia nervosa, they often fear gaining weight, want desperately to lose weight, and are intensely unhappy with their body size and shape. Usually, bulimic behavior is done secretly because it is often accompanied by feelings of disgust or shame. The binge-eating and purging cycle happens anywhere from several times a week to many times a day.
Other symptoms include:^7,8

• Chronically inflamed and sore throat
• Swollen salivary glands in the neck and jaw area
• Worn tooth enamel, increasingly sensitive and decaying teeth as a result of exposure to stomach acid
• Acid reflux disorder and other gastrointestinal problems
• Intestinal distress and irritation from laxative abuse
• Severe dehydration from purging of fluids
• Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium and other minerals) which can lead to heart attack.

Binge-Eating Disorder

 

With binge-eating disorder a person loses control over his or her eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder often are over-weight or obese. People with binge-eating disorder who are obese are at higher risk for developing cardiovascular disease and high blood pressure.⁹ They also experience guilt, shame, and distress about their binge-eating, which can lead to more binge-eating.

Treatment For Eating Disorders

Adequate nutrition, reducing excessive exercise, and stop-ping purging behaviors are the foundations of treatment. Specific forms of psychotherapy, or talk therapy, and medica-tion are effective for many eating disorders. However, in more chronic cases, specific treatments have not yet been identified. Treatment plans often are tailored to individual needs and may include one or more of the following:

• Individual, group, and/or family psychotherapy
• Medical care and monitoring
• Nutritional counseling
• Medications.

Some patients may also need to be hospitalized to treat problems caused by malnutrition or to ensure they eat enough if they are very underweight.
 

Treating Anorexia Nervosa

 

Treating anorexia nervosa involves three components:

• Restoring the person to a healthy weight
• Treating the psychological issues related to the eating disorder
• Reducing or eliminating behaviors or thoughts that lead to insufficient eating and preventing relapse.

Some research suggests that the use of medications, such as antidepressants, antipsychotics, or mood stabilizers, may be modestly effective in treating patients with anorexia nervosa. These medications may help resolve mood and anxiety symptoms that often occur along with anorexia nervosa. It is not clear whether antidepressants can prevent some weight-restored patients with anorexia nervosa from relapsing.¹⁰ Although research is still ongoing, no medication yet has shown to be effective in helping someone gain weight to reach a normal level.¹¹

Different forms of psychotherapy, including individual, group, and family-based, can help address the psychological reasons for the illness. In a therapy called the Maudsley approach, parents of adolescents with anorexia nervosa assume responsibility for feeding their child. This approach appears to be very effective in helping people gain weight and improve eating habits and moods.^12,13 Shown to be effective in case studies and clinical trials,¹⁴ the Maudsley approach is discussed in some guidelines and studies for treating eating disorders in younger, nonchronic patients.^11,12,15-18

Other research has found that a combined approach of medical attention and supportive psychotherapy designed specifically for anorexia nervosa patients is more effective than psychotherapy alone.¹⁹ The effectiveness of a treatment depends on the person involved and his or her situation. Unfortunately, no specific psychotherapy appears to be consistently effective for treating adults with anorexia nervosa.²⁰ However, research into new treatment and prevention approaches is showing some promise. One study suggests that an online intervention program may prevent some at-risk women from developing an eating disorder.²¹ Also, specialized treatment of anorexia nervosa may help reduce the risk of death.²²

Treating Bulimia Nervosa

 

As with anorexia nervosa, treatment for bulimia nervosa often involves a combination of options and depends upon the needs of the individual. To reduce or eliminate binge-eating and purging behaviors, a patient may undergo nutritional counseling and psychotherapy, especially cognitive behavioral therapy (CBT), or be prescribed medication. CBT helps a person focus on his or her current problems and how to solve them. The therapist helps the patient learn how to identify distorted or unhelpful thinking patterns, recognize, and change inaccurate beliefs, relate to others in more positive ways, and change behaviors accordingly.

CBT that is tailored to treat bulimia nervosa is effective in changing binge-eating and purging behaviors and eating attitudes.²³ Therapy may be individual or group-based.

Some antidepressants, such as fluoxetine (Prozac), which is the only medication approved by the U.S. Food and Drug Administration (FDA) for treating bulimia nervosa, may help patients who also have depression or anxiety. Fluoxetine also appears to help reduce binge-eating and purging behaviors, reduce the chance of relapse, and improve eating attitudes.²⁴

Treating Binge-Eating Disorder

 

Treatment options for binge-eating disorder are similar to those used to treat bulimia nervosa. Psychotherapy, especially CBT that is tailored to the individual, has been shown to be effective.²³ Again, this type of therapy can be offered in an individual or group environment.

Fluoxetine and other antidepressants may reduce binge-eating episodes and help lessen depression in some patients.²⁵

FDA Warnings on Antidepressants
 
Antidepressants are safe and popular, but some studies have suggested that they may have unintentional effects on some people, especially in adolescents and young adults. The FDA warning says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment. Possible side effects to look for are depression that gets worse, suicidal thinking or behavior, or any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal from normal social situations. Families and caregivers should report any changes to the doctor. For the latest information visit the FDA website.

Effect of Eating Disorders on Males

Like females who have eating disorders, males also have a distorted sense of body image. For some, their symptoms are similar to those seen in females. Others may have muscle dysmorphia, a type of disorder that is characterized by an extreme concern with becoming more muscular.26 Unlike girls with eating disorders, who mostly want to lose weight, some boys with muscle dysmorphia see themselves as smaller than they really are and want to gain weight or bulk up. Men and boys are more likely to use steroids or other dangerous drugs to increase muscle mass.²⁶

Although males with eating disorders exhibit the same signs and symptoms as females, they are less likely to be diagnosed with what is often considered a female disorder.²⁷ More research is needed to understand the unique features of these disorders among males.
 
Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors. But many questions still need answers. Researchers are using the latest in technology and science to better understand eating disorders.

One approach involves the study of human genes. Researchers are studying various combinations of genes to determine if any DNA variations are linked to the risk of developing eating disorders.

Neuroimaging studies are also providing a better understanding of eating disorders and possible treatments. One study showed different patterns of brain activity between women with bulimia nervosa and healthy women. Using functional magnetic resonance imaging (FMRI), researchers were able to see the differences in brain activity while the women performed a task that involved self-regulation (a task that requires overcoming an automatic or impulsive response).²⁸

Psychotherapy interventions are also being studied. One such study of adolescents found that more adolescents with bulimia nervosa recovered after receiving Maudsley model family-based treatment than those receiving supportive psychotherapy, that did not specifically address the eating disorder.²⁹

Researchers are studying questions about behavior, genetics, and brain function to better understand risk factors, identify biological markers, and develop specific psychotherapies and medications that can target areas in the brain that control eating behavior. Neuroimaging and genetic studies may provide clues for how each person may respond to specific treatments for these medical illnesses.

 

Citations

1. Becker AE, Grinspoon SK, Klibanski A, Herzog DB. Eating disorders. New England Journal of Medicine, 1999; 340(14):1092–1098.
2. Steiner H, Lock J. Anorexia nervosa and bulimia nervosa in children and adolescents: a review of the past ten years. Journal of the American Academy of Child and Adolescent Psychiatry, 1998; 37:352–359.
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Washington, DC: American Psychiatric Press, 1994.
4. Fairburn CG, Cooper Z, Bohn K, O’Connor ME, Doll HA, Palmer RL. The severity and status of eating disorder NOS: implications for DSM-V. Behaviour Research and Therapy, 2007; 45(8):1705–1715.
5. Steinhausen HC. Outcomes of eating disorders. Child and Adolescent Psychiatric Clinics of North America, 2008; 18:225–242.
6. Wonderlich SA, Lilenfield LR, Riso LP, Engel S, Mitchell JE. Personality and anorexia nervosa. International Journal of Eating Disorders, 2005; 37:S68–S71.
7. American Psychiatric Association (APA). Let’s Talk Facts About Eating Disorders. 2005. Available online at http://www.healthyminds.org/Document-Library/Brochure-Library/Eating-Disorders.aspx.
8. Lasater L, Mehler P. Medical complications of bulimia nervosa. Eating Behavior, 2001; 2:279–292.
9. National Institutes of Health National Heart Lung and Blood Institute. Why obesity is a health problem. http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/healthy-weight-basics/obesity.htm. Accessed on May 3, 2010.
10. Walsh BT, Kaplan AS, Attia E, Olmsted M, Parides M, Carter JC, Pike KM, Devlin MJ, Woodside B, Roberto CA, Rockert W. Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial. Journal of the American Medical Association, 2006; 295(22): 2605–2612.
11. Agency for Healthcare Research and Quality (AHRQ), Management of Eating Disorders, Evidence Report/Technology Assessment, Number 135, 2006. AHRQ publication number 06-E010, www.ahrq.gov.
12. Eisler I, Dare C, Hodes M, Russell G, Dodge E, and Le Grange D. Family therapy for adolescent anorexia nervosa: the results of a controlled comparison of two family interventions. Journal of Child Psychology and Psychiatry, 2000; 1:727–736.
13. Lock J, Le Grange D, Agras WS, Dare C. Treatment Manual for Anorexia Nervosa: A Family-based Approach. New York: Guilford Press. 2001.
14. Russell GF, Szmuckler GI, Dare C, Eisler I. An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Archives of General Psychiatry, 1987; 44:1047–1056.
15. Lock J, Agras WS, Bryson S, Kraemer HC. A comparison of short-and long-term family therapy for adolescent anorexia nervosa. Journal of the American Academy of Child and Adolescent Psychiatry, 2005; 44:632–639.
16. Lock J, Couturier J, Agras WS. Comparison of long-term outcomes in adolescents with anorexia nervosa treated with family therapy. Journal of the American Academy of Child and Adolescent Psychiatry, 2006; 45:666–672.
17. National Institute for Clinical Excellence (NICE). Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa, and binge eating disorder. London: British Psychological Society. 2004.
18. Eisler I, Simic M, Russell G, Dare C. A randomized controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: a five-year follow-up. Journal of Child Psychology and Psychiatry, 2007; 48(6):552–560.
19. McIntosh VV, Jordan J, Carter FA, Luty SE, McKenzie JM, Bulik CM, Frampton CM, Joyce PR. Three psychotherapies for anorexia nervosa: a randomized controlled trial. The American Journal of Psychiatry, 2005; 162:741–747.
20. Halmi CA, Agras WS, Crow S, Mitchell J, Wilson GT, Bryson S, Kraemer HC. Predictors of treatment acceptance and completion in anorexia nervosa: implications for future study designs. Archives of General Psychiatry, 2005; 62:776–781.
21. Taylor CB, Bryson S, Luce KH, Cunning D, Doyle AC, Abascal LB, Rockwell R, Dev P, Winzelberg AJ, Wilfley DE. Prevention of eating disorders in at-risk college-age women. Archives of General Psychiatry, 2006; 63(8):881–888.
22. Lindblad F, Lindberg L, Hjern A. Improved survival in adolescent patients with anorexia nervosa: a comparison of two Swedish national cohorts of female inpatients. American Journal of Psychiatry, 2006; 163(8):1433–1435.
23. Wilson GT and Shafran R. Eating disorders guidelines from NICE. Lancet, 2005; 365:79–81.
24. Romano SJ, Halmi KJ, Sarkar NP, Koke SC, Lee JS. A placebo-controlled study of fluoxetine in continued treatment of bulimia nervosa after successful acute fluoxetine treatment. American Journal of Psychiatry, 2002; 151(9):96–102.
25. Arnold LM, McElroy SL, Hudson JI, Wegele JA, Bennet AJ, Kreck PE Jr. A placebo-controlled randomized trial of fluoxetine in the treatment of binge-eating disorder. Journal of Clinical Psychiatry, 2002; 63:1028–1033.
26. Pope HG, Gruber AJ, Choi P, Olivardi R, Phillips KA. Muscle dysmorphia: an underrecognized form of body dysmorphic disorder. Psychosomatics, 1997; 38:548–557.
27. Anderson, AE. Eating disorders in males: critical questions. In R Lemberg (ed), Controlling Eating Disorders with Facts, Advice and Resources. Phoenix, AZ: Oryx Press, 1992; 20–28.
28. Marsh R, Steinglass JE, Gerber AJ, Graziano O’Leary K, Wang Z, Murphy D, Walsh BT, Peterson BS. Deficient activity in the neural systems that mediate self-regulatory control in bulimia nervosa. Archives of General Psychiatry. 2009; 66(1):51–63.
29. Le Grange D, Crosby RD, Rathouz PJ, Leventhal BL. A randomized controlled comparison of family-based treatment and supportive psychotherapy for adolescent bulimia nervosa. Archives of General Psychiatry. 2007; 64(9):1049–1056.

This article is in the public domain of NIMH publications and may be reproduced or copied without the permission from the National Institute of Mental Health. For complete guidelines regarding the reproduction of this article, you may call their Information Resource Center at 1-866-615-6464 or send an email to nimhinfo@nih.gov.

“I've learned that no matter what happens, or how bad it seems today, life does go on, and it will be better tomorrow.

I've learned that you can tell a lot about a person by the way he/she handles these three things: a rainy day, lost luggage, and tangled Christmas tree lights.

I've learned that regardless of your relationship with your parents, you'll miss them when they're gone from your life.

I've learned that making a "living" is not the same thing as making a "life."

I've learned that life sometimes gives you a second chance.

I've learned that you shouldn't go through life with a catcher's mitt on both hands; you need to be able to throw something back.

I've learned that whenever I decide something with an open heart, I usually make the right decision.

I've learned that even when I have pains, I don't have to be one.

I've learned that every day you should reach out and touch someone. People love a warm hug, or just a friendly pat on the back.

I've learned that I still have a lot to learn. I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel."

-Maya Angelou

Let us try to have a stress-free Christmas, shall we? I've been beating myself up for getting behind on everything while I was sick this past week, but self-loathing never helped anyone, so instead I am going to focus on the positive. We have a great meal planned, and I look forward to spending time with my family. I may have to take breaks along the way,  I may have to go to the other room for a breather here and there, but the important thing is that I keep my efforts focused on the things that truly matter, and to not get bogged down emotionally with the silly things like having everything just right like a good hostess "should". I'm Amy. I don't have it altogether. Not at Christmas, not ever. My nerves will be frazzled to a certain extent regardless. But I am strong and I can do my best, and that is perfectly good enough. What's more, my family loves me just the way I am, frazzled and not-together and emotionally unstable as I can be. They don't require me to be perfect. They just want me to be present. That's all any of us really have to be. Present and open to the days, the moments, the memories. Do what you can, and let that be enough. I wish you all a wonderful and memorable holiday. Be safe, be merry, and be your beautiful self!

Stress: How It Affects Your Health and What You Can Do

Stress — just the word may be enough to set your nerves on edge. Everyone feels stressed from time to time. Some people may cope with stress more effectively or recover from stressful events quicker than others. It's important to know your limits when it comes to stress to avoid more serious health effects.

 

What is stress?

 

Stress can be defined as the brain's response to any demand. Many things can trigger this response, including change. Changes can be positive or negative, as well as real or perceived. They may be recurring, short-term, or long-term and may include things like commuting to and from school or work every day, traveling for a yearly vacation, or moving to another home. Changes can be mild and relatively harmless, such as winning a race, watching a scary movie, or riding a rollercoaster. Some changes are major, such as marriage or divorce, serious illness, or a car accident. Other changes are extreme, such as exposure to violence, and can lead to traumatic stress reactions.

How does stress affect the body?

 

Not all stress is bad. All animals have a stress response, which can be life-saving in some situations. The nerve chemicals and hormones released during such stressful times, prepares the animal to face a threat or flee to safety. When you face a dangerous situation, your pulse quickens, you breathe faster, your muscles tense, your brain uses more oxygen and increases activity—all functions aimed at survival. In the short term, it can even boost the immune system.

However, with chronic stress, those same nerve chemicals that are life-saving in short bursts can suppress functions that aren't needed for immediate survival. Your immunity is lowered and your digestive, excretory, and reproductive systems stop working normally. Once the threat has passed, other body systems act to restore normal functioning. Problems occur if the stress response goes on too long, such as when the source of stress is constant, or if the response continues after the danger has subsided.

How does stress affect your overall health?

 

There are at least three different types of stress, all of which carry physical and mental health risks:

• Routine stress related to the pressures of work, family and other daily responsibilities.
• Stress brought about by a sudden negative change, such as losing a job, divorce, or illness.
• Traumatic stress, experienced in an event like a major accident, war, assault, or a natural disaster where one may be seriously hurt or in danger of being killed.

The body responds to each type of stress in similar ways. Different people may feel it in different ways. For example, some people experience mainly digestive symptoms, while others may have headaches, sleeplessness, depressed mood, anger and irritability. People under chronic stress are prone to more frequent and severe viral infections, such as the flu or common cold, and vaccines, such as the flu shot, are less effective for them.

Of all the types of stress, changes in health from routine stress may be hardest to notice at first. Because the source of stress tends to be more constant than in cases of acute or traumatic stress, the body gets no clear signal to return to normal functioning. Over time, continued strain on your body from routine stress may lead to serious health problems, such as heart disease, high blood pressure, diabetes, depression, anxiety disorder, and other illnesses.

How can I cope with stress?

 

The effects of stress tend to build up over time. Taking practical steps to maintain your health and outlook can reduce or prevent these effects. The following are some tips that may help you to cope with stress:

• Seek help from a qualified mental health care provider if you are overwhelmed, feel you cannot cope, have suicidal thoughts, or are using drugs or alcohol to cope.
• Get proper health care for existing or new health problems.
• Stay in touch with people who can provide emotional and other support. Ask for help from friends, family, and community or religious organizations to reduce stress due to work burdens or family issues, such as caring for a loved one.
• Recognize signs of your body's response to stress, such as difficulty sleeping, increased alcohol and other substance use, being easily angered, feeling depressed, and having low energy.
• Set priorities-decide what must get done and what can wait, and learn to say no to new tasks if they are putting you into overload.
• Note what you have accomplished at the end of the day, not what you have been unable to do.
• Avoid dwelling on problems. If you can't do this on your own, seek help from a qualified mental health professional who can guide you.
• Exercise regularly-just 30 minutes per day of gentle walking can help boost mood and reduce stress.
• Schedule regular times for healthy and relaxing activities.
• Explore stress coping programs, which may incorporate meditation, yoga, tai chi, or other gentle exercises.

 If you or someone you know is overwhelmed by stress, ask for help from a health professional. If you or someone close to you is in crisis, call the toll-free, 24-hour National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).

This article is in the public domain of NIMH publications and may be reproduced or copied without the permission from the National Institute of Mental Health. For complete guidelines regarding the reproduction of this article, you may call their Information Resource Center at 1-866-615-6464 or send an email to nimhinfo@nih.gov.

The Ugly Parts

I've spent the past two days in a haze of nauseating vertigo, an unyielding sense of imbalance and exposure, and along with the physical drain I have felt my sanity slowly seep out through the pores. I am at a breaking point, and I suddenly understand, more than ever before, what makes people do horrible things. It isn't evil. It isn't desperation. It is a fine tuning of the senses. A parting from the ordinary, because that ordinary suffocates. These horrible things dart in and out of the lines that bind us all in structure, in formality. Therein lies the problem, and the solution. Tangled together, they cancel out one another, and where that leaves us is anyone's guess.

The days leading up to today: what a horrible place indeed. The shooting. All of those innocent children. Innocence, the most prized possession among us, slain before our very eyes. I have tried to block it out because I knew what it would do to me. But to block out humanity, and the flaws within, has proved impossible. Tidbits have floated through my mind and have left behind a sickening residue of grief. I can't begin to know what it is to lose a child, but I have known the fault of taking a child for granted, of wishing for an escape, for playing the part of a prisoner to all I once found freedom in. I have known the loss of all I had, and while not altogether the same as death, it is a death, it is, and I feel too much-not enough-for families I have never met, for children I have never nursed, because in each of them I see myself, and every life lost is a scar on my heart reopened. I see murder as an escape, as a saving of what could have been. These lives remained innocent to the end. What of the rest of us? We are left here to grow old and sour. I hate us all for that.

Part of me wishes the world would end tomorrow. No more worry of pain, of the potential of God or gods, of prophecies unfolding, of mischief and religion and apathy and lies. Wrong or right, the fight would be over. No more speculating. No more second chances, or the dance of doubts that so often tires even the most faithful. I don't want to know how bad things could still get. I don't want to know what dying feels like; I only want a clear and soundless death. I want all the pain to end, the madness, the heartlessness. I want the rich to stop complaining about their rich lives, as if they know what it is to be poor. I want the poor to eat a fine dinner, or have a home that does not feel borrowed and lacking, to know what it is to only worry about the simple things that rich people do. I want the murderers to know what the piercing of their skin feels like, that harsh blow to the insides. I want the victims to know what holding the solidity of a life in their own hands feels like. I want the political to just shut up and listen. I want the spiritual to pray diligently, whether their god is real or not. I want their mouths to be silenced, their souls laid open like gutted fish. Be still and know. Be still and know.

I make no apology for my thoughts. I explain nothing. Doubts and hope spout their cases ear by ear, but nothing sounds as loud as my own fear. And from that fear comes a numbness, a way of blinding the worst of it, the ugly parts, the truth.

Roasted Chicken Breasts with Peppers and Mushrooms

This is a simple recipe that can be prepared in 30 minutes. Great for a weekday meal!

Ingredients

• 3/4 teaspoon salt, divided
• 1/2 teaspoon pepper, divided
• 1/4 teaspoon garlic powder
• 1/4 teaspoon dried oregano
• 4 boneless skinless chicken breast halves (5 ounces each)
• 2 teaspoons plus 1 tablespoon olive oil, divided
• 1 large sweet red pepper, thinly sliced
• 1 medium sweet yellow pepper, thinly sliced
• 1 small package of sliced mushrooms
• 4 shallots, thinly sliced
• 1 cup chicken broth
• 1-1/2 teaspoons minced fresh rosemary
• 1 tablespoon balsamic vinegar

Directions

• Mix 1/2 tsp. salt, 1/4 tsp. pepper, garlic powder and oregano together. Sprinkle over chicken.Use a little meat tenderizer, if you wish.
• Heat 2 teaspoons oil over medium-high heat. Brown chicken, about 2 minutes on each side. Transfer to a baking dish. Bake at 450° for 10-15 minutes or until a thermometer reads 170°.
• Meanwhile, heat remaining oil in the same skillet. Add peppers, mushrooms and shallots; cook and stir over medium heat until crisp-tender.
• Add broth and rosemary, stirring to loosen browned bits from pan. Bring to a boil; cook for 4-6 minutes or until broth is almost evaporated. Stir in vinegar and remaining salt and pepper. Serve with chicken. 

 Yield: 4 servings.

Neuroimaging and Mental Illness: A Window Into the Brain

Brain imaging scans, also called neuroimaging scans, are being used more and more to help detect and diagnose a number of medical disorders and illnesses. Currently, the main use of bran scans for mental disorders is in research studies to learn more about the disorders. Brain scans alone cannot be used to diagnose a mental disorder, such as autism, anxiety, depression, schizpohrenia, or bipolar disorder.

In some cases, a brain scan might be used to rule out other medical illnesses, such as a tumor, that could cause symptoms similar to a mental disorder, such as depression. Other types of tests are needed for a mental illness to be properly diagnosed. Scientists are studying differences in the brains of people with and without a mental illness to learn more about these disorders. However, at this time relying on brain scans alone cannot accurately diagnose a mental illness or tell you your risk of getting a mental illness in the future.

Some types of brain scans pose health risks due to the radiation they use to create a picture of the brain. Because of these risks, brain scans should not be used if you don't need them. In addition, these scans are very expensive, and unless your doctor prescribes such a test, they may not be fully covered by health insurance.

What Brain Scans Can Do

• Show damage to brain tissue, the skull, or blood vessels in the brain
• Be used with other medical tests to help doctors find the right diagnosis for mood and behavioral problems
• Help researchers study healthy brain development, effects of mental illnesses or effects of mental health treatments on the brain.

What Brain Scans Cannot Do

• Diagnose mental illness when used by themselves
• Predict risk of getting a mental illness.

Frequently Asked Questions about Brain Scans

Can a brain scan tell me what mental disorders I have or might get?

No scientific studies to date have shown that a brain scan by itself can be used for diagnosing a mental illness or to learn about a person's risk for disease. Researchers use brain scans to study brain development in healthy people and people with illnesses, disease progression, and the effects of medications or other treatments on the brain.

In practice, when used with other types of medical tests and done by an experienced doctor, brain scans can be used to confirm a diagnosis of a small number of disorders, such as brain tumors, where there is obvious damage in the brain. Brain scans are not usually the first test a doctor would do to diagnose changes in mood and behavior. Other medical tests a doctor may use include behavioral and cognitive tests or a medical interview.

Researcher analyzes FMRI brain images

Should I have a brain imaging scan?

 

When used with other medical tests, they can provide useful information about:

• Brain tumors, infections, and other brain diseases
• Bleeding, blood clots, or other signs of stroke
• Skull fractures or brain damage from head injuries
• Diseases or disorders affecting the skull or blood vessels in the brain.

What types of brain scans, or neuroimaging tests, are there?

 

There are two main types of neuroimaging tests: structural and functional.

• Structural imaging creates a "snapshot" of the brain's structure, including bone, tissue, blood vessels, tumors, infection, damage, or bleeding such as from a stroke.
• Functional imaging reveals the brain's ever-changing activity and chemistry by measuring the rate of blood flow, chemical activity, and electrical impulses in the brain during specific tasks.

 
Patient enters PET scan machine.

Are there risks associated with brain scans?

 

Brain scans are relatively safe and do not cause any pain. However, risks include exposure to magnetic fields and radiation. Safety measures are used to limit these risks such as using the lowest possible radiation or magnetic level to do the scan.

Children and teens may be more sensitive to these risks. If your child needs a brain scan, ask if there are special precautions you can take or whether a different type of brain scan can be used. Ask the doctor doing the scan if the machine's settings have been adjusted for a child.

Women who are pregnant or breastfeeding should also talk with their doctor about how to prepare for any type of brain scan. While most types of scans pose little risk to the developing fetus, the doctor may make different recommendations to accommodate pregnancy.

Another possible risk is claustrophobia, or a fear of small spaces. Many brain scanning machines look like large tubes or giant "donuts" that are open on both ends. The machines can be very loud while scanning takes place. Some people feel scared or nervous when inside the machines. Sometimes, an injury or other medical condition can make it uncomfortable or painful for a person to hold a certain position.

It is important to stay still in order to get a clear picture. Tell your doctor if you are afraid of being inside the brain scanning machine or think you cannot stay still for any other reason. The doctor can give you a sedative to help you lie still, or may suggest a different type of test entirely.

Talk with your doctor to make sure you understand the possible risks and benefits before deciding to get a brain scan. In general, a person should not need more than one of the same type of brain scan. If a doctor recommends a brain scan that you've already done in the past, ask if you really need to get the test repeated.

 
Patient in MEG scanner

What can research using brain imaging technologies tell us about disease risk?

 

As they continue to learn more about how the healthy brain develops and which processes may contribute to specific diseases, scientists are building a more complete picture of how to detect which people are at risk of common diseases.

This research also is helping to reveal biological pathways that guide thoughts and emotions, and how experiences, medications, or environmental substances affect the brain. Scientists can use this information to design better screening and prevention for specific disorders, and improve on the delivery and effectiveness of mental health treatments.

Technician checks MRI machine.

Risk from magnetic fields:*

Magnetic resonance imaging (MRI) Functional magnetic resonance imaging (FMRI) Magnetic resonance spectroscopy (MRS)

These scans use strong magnets to develop pictures of the brain. This means that a person must remove all jewelry, piercings, and clothing with metal before entering the scanning machine. Medication patches, such as nicotine patches or ones that release hormones, sometimes contain metal in the sticky backing, which can burn the skin if worn during an MRI. If you use such patches, talk to your doctor about if and when you should remove them. It's important to tell your doctor if you have any metal in your body, such as metal braces or metal fillings in your teeth, embedded bullets, shrapnel, or implanted medical devices - pacemakers, aneurysm clips, medication pumps, metal plates, screws, or pins. If located close to the head, they may distort the scanned image. Sometimes, the strong magnetic field causes these objects to move, which can cause an injury. If you're not sure about your risk, check with the doctor before getting this type of brain scan.

* Magnetoencephalography (MEG) scanning does not carry these risks because it does not use magnets.

Risk from radiation: Computed tomography (CT) or computed axial tomography (CAT) Positron emission tomography (PET) Single positron emission computed tomography (SPECT) These scans expose people to low levels of radiation. For example, the amount of radiation from one CT scan of the head is about the same as the amount that the average person receives from natural sources of radiation over eight months.1 Natural sources of radiation include naturally occurring radioactive materials and cosmic rays such as emitted by the sun. Also, some people may be allergic to the chemicals, called contrast dyes or tracers, used to make sure brain structures show up in these types of scans. In some cases, these chemicals are radioactive but lose their potency fairly quickly. If you have ever had a bad reaction to a contrast dye or tracer, tell the doctor before you get the scan. In general, children should not have PET or SPECT scans. This article is in the public domain of NIMH publications and may be reproduced or copied without the permission from the National Institute of Mental Health. For complete guidelines regarding the reproduction of this article, you may call their Information Resource Center at 1-866-615-6464 or send an email to nimhinfo@nih.gov.