DEPRESSED PEOPLE ARE LITERALLY UNABLE TO SEE SHADE OF GRAY

July 30th, 2010

It has often been said that major depression is a condition of extremes, leaving the depressed person thinking only in terms of worst case scenarios, blaming himself for whatever goes wrong in his life, refusing to allow himself to experience pleasure and refusing to give himself credit for any positive accomplishment. Non-depressed people moderate their vision of themselves and the world around them. They see the world as good and the bad. They can experience pleasure as well as pain. They sometimes blame themselves and sometimes blame others. They alternate between hope and fear. In a figurative sense depressed people are unable to see shades of gray while non-depressed people can.

We have just learned that depressed people are literally much less able than non-depressed people to see shades of gray. In the July 15, 2010, issue of Biological Psychiatry, a group of researchers led by Emanuel Bubl of the Albert-Ludwigs-University of Freiburg published their study on the use of pattern electroretinogram assessment (PERG) on the eyes of depressed and non-depressed people. An electroretinogram is a machine which measures how the retina responds to visual contrast. Dr. Bubl wanted to find out if depressed patients had reduced sensitivity to contrast perception.

His group recruited and studied forty patients with a diagnosis of major depression (20 with and 20 without medication) and 40 matched healthy subjects. They recorded visual PERGs from both eyes of all study participants. Unmedicated and medicated depressed patients displayed dramatically lower retinal contrast perception, meaning they were much less able to detect shades of gray. The researchers found a strong and significant correlation between contrast perception and severity of depression. Computerized analysis revealed a specificity of 92.5% and a sensitivity of 77.5% for classifying the participants correctly. Because PERG recordings do not depend on subjective ratings by an optometrist, this decrement in the ability of a person’s retina to detect shades of gray is a marker or objective correlate of major depression which can be used for diagnostic purposes.

At this point we do not know why the retinas of people with major depression are so much less able to appreciate visual contrast between the shades of gray that lie between pure black and white. Perhaps neuro-ophthalmologists and neuro-psychiatrists will be able to answer this question in the future. Meanwhile it is a very intriguing piece of data which joins together our visual-psychological metaphor and our medical-ophthalmological understanding of depressed people as being unable to appreciate shades of gray.

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STRONG SOCIAL RELATIONSHIPS EXTEND LIFETIMES BY 50%

July 29th, 2010

People in industrialized countries are experiencing a steady decline in the quantity and quality of social relationships. In Bowling Alone Robert D. Putnam said Americans have gone from a society of joiners to one of loners. He convincingly documented this by marshaling statistics which show startling declines in the membership of political parties, labor unions, civic organizations, religious and charitable organizations, neighborhood associations, sports clubs and so forth. Contemporary social trends along these lines are  reduced inter-generational living, greater social mobility, delayed marriage, dual-career families, increased single-residence households, and increased age-related disabilities. Over the last two decades there has been a three-fold increase in the number of Americans who report having no confidant.

Does lack of meaningful human contact and good social relationships predict early death? The answer is yes. In a study published in the online journal PLOS Medicine in July 2010 University of Utah psychologists Julianne Holt-Lunstad and Timothy B. Smith and UNC epidemiologist J. Bradley Layton performed a meta-analysis on 148 scientific research papers dealing with the link between social relationships with morbidity and mortality. The studies looked length of survival in 308,849 participants who were followed for an average of 7.5 years. The meta-analysis demonstrated a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period.

In their conclusion the researchers say that individuals with adequate social relationships have a 50% greater likelihood of survival compared to those with poor or insufficient social relationships. The magnitude of this effect is comparable with quitting smoking and it exceeds many well-known risk factors for mortality (e.g., obesity, physical inactivity).

Lawyers and other busy professionals need to take this conclusion very seriously. Too many of us spend the bulk of our waking hours working, commuting, thinking about work, preparing for work, and soothing ourselves to relieve the stress of work. We make resolutions to spend more time with family members, but do we keep them? Some of us only see family for milestone birthdays, marriages and funerals. When we run into old friend we say “it’s been way too long, we’ve just got to get together soon,” but how often do we actually follow up? More and more people substitute Facebook communication via the Internet for real in-the-flesh socializing.

How does friendship make us happier, healthier people who lead longer lives?
The authors of the PLOS Medicine article say social relationships buffer stressors which would otherwise damage individual health. They provide resources (informational, emotional, or tangible) that promote adaptive behavioral responses to acute or chronic stressors (e.g., illness, life events, life transitions). Just having friends and knowing that social support is available can increase a person’s stress tolerance. Spending time with friends and sharing a laugh lowers cortisol and increases endorphins. Social relationships may directly encourage or indirectly model healthy behaviors. Loners have less incentive than people in active social networks to engage in self-care and good hygiene. Being part of a social network gives individuals meaningful roles that provide self-esteem and a life purpose. Being alone during non-work hours can be taken as proof that one’s life isn’t meaningful or that other people don’t care about you.

We are social creatures. Our survival during pre-historic times depended on staying together in small, cohesive groups marked by a high degree of cooperation. People have a strong inner need to contribute to the lives of others, to give and receive human touch, and to exchange admiration, appreciation and affection with people they care about. When we experience something truly interesting, beautiful or awe inspiring we naturally want to share it with a friend. When we are lonely, scared or sad we long to share our feelings with a confidant and get his or her support.

Ultimately it’s so much better for our health and happiness to let go of the  chance to make that one extra dollar and spend that time with a friend instead. The real bottom line is not what you have in the bank, but how long you’ll live to enjoy your family, friends, and everything else that brings you joy. If the thought of spending more time socializing and less time at the office makes you apprehensive about your financial bottom line, then remember that avoiding social relationships will significantly increase your odds of dying. To have friends you have to be a friend. Believe me it pays off. Your life will be way more enjoyable and your odds of survival will increase by 50%  Isn’t that the best deal in town?

Right after finishing this blog entry I received a touching  email from my sister-in-law Lori Carlson Watsky in Austin, TX, about the value of friendship. I’m reprinting it here because it so beautifully captures why we need friends:

“If you happened to read a recent front page story of the SF Chronicle, You would have read about a female humpback whale that had become entangled in a spider web of crab traps and lines. She was weighted down by hundreds of pounds of traps that caused her to struggle to stay afloat. She also had hundreds of yards of line rope wrapped around her body,  her tail, her torso, a line tugging in her mouth.

A fisherman spotted her just east of the Farallon Islands (outside the Golden Gate ) and radioed an environmental group for help. Within a few hours, the rescue team arrived and determined that she was so bad off, the only way to save her was to dive in and untangle her. They worked for hours with curved knives and eventually freed her.

When she was free, the divers say she swam in what seemed like joyous circles. She then came back to each and every diver, one at a time,  and nudged them, pushed them gently around…she was thanking them. Some said it was the most incredibly beautiful experience of their lives. The guy who cut the rope out of her mouth said her eyes were following him the whole time, and he will never be the same.

May you, and all those you love, be so blessed and fortunate to be surrounded by people who will help you get untangled from the things that are binding you. And, may you always know the joy of giving and receiving gratitude. I pass this on to you, my friends, in the same spirit.”

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RELIEVE STRESS THROUGH CHORES DONE IN A MEDITATIVE SPIRIT

July 28th, 2010

Our homes manifest the law of entropy. The moment we get the clothes washed, dried, folded, and put away, and kids’ things picked up off the floor, everything gets messy again. A few people I know (like my wife) can’t rest until their homes are clean, neat and well organized. Many of us (me included) look at home cleaning chores somewhat resentfully, wishing they would somehow take care of themselves and leave us alone.

Lawyers and the many other people who work in offices all day solving other people’s problems come home feeling worn and depleted. They want to rest and they want to be soothed. The last thing they want to do is some type of chore, which means the dishes remain piled up in the sink, the high stack of unpaid bills on the desk leans like the Tower of Pisa and the dust balls move across the floor like tumbleweeds. Various people soothe themselves in different ways. Some go to Happy Hour. Some go home and drink wine. Some flop on the couch, turn on the TV and channel surf. All of those things seem so much better than doing those damned dishes.

There are several draw backs to this mode of living. One is that clutter catches up with us and eventually the house resembles a jungle. Just looking at the clutter adds to your stress. If  your spouse does all the cleaning, you can count on him or her using the death stare if you seek affection. Guzzling alcohol or being a couch potato does not relieve the stress you accumulate at the office in a healthy way which leaves you with greater mental clarity, energy and zest. Thirdly, these modes of self-soothing deprive you of contact with the joy of living that comes from being truly present and mindful.

Thich Nhat Hanh put it best in The Miracle of Mindfulness when he said:

“To my mind, the idea that doing dishes is unpleasant can occur only when you aren’t doing them…I enjoy taking my time with each dish, being fully aware of the dish, the water, and each movement of my hands.  I know that if I hurry in order to eat dessert sooner, the time of washing dishes will be unpleasant and not worth living.  That would be a pity, for each minute, each second of life is a miracle.”

Tonight when you get home wash the dishes mindfully in the meditative spirit discussed by Thich Nhat Hanh and see what happens. You can always go back to the wine or TV, but you may find you don’t even need them. You may find that you want to read a good book, take a walk, hang out with your kids or spend some face time with your spouse really listening to what his or her day was like. Sit quietly. Take a deep breath. Imagine it. Do it.

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SUICIDE RISK INCREASED BY SOME BUT NOT ALL ANTI-CONVULSANT DRUGS USED AS MOOD STABILIZERS FOR BIPOLAR DISORDER

July 27th, 2010

In recent times psychiatrists have begun moving away from Lithium and toward anti-convulsant drugs for long term stabilization of mood in patients with bipolar disorder. Anti-convulsants are drugs which were initially designed and FDA approved to prevent seizures in persons with epilepsy. Although anti-convulsants appear to work as a mood stabilizer for bipolar patients, questions have been raised about their safety, because some studies showed they increased the probability of suicide in the patients who take them. In December 2008 the FDA required all manufacturers of anti-convulsants to insert a warning about increased risk of suicide in the box without specifying the relative risks of particular brands. This move by the FDA was precipitated by its analysis of 199 clinical trials of 11 anti-epileptic drugs which showed that patients receiving anti-epileptic drugs had almost twice the risk of suicidal behavior or thoughts compared to patients receiving a placebo.

Bipolar I involves shifting back and forth from mania to depression, while Bipolar II involves shifting back and forth from hypomania (a less intense form of mania) to depression. Since bipolar disorder involves a depressive phase which can be highly serious and lead to suicidal thoughts, acts of self-harm or even completed suicide, it’s necessary to treat bipolar patients with an anti-depressant. These days anti-depressants are the most commonly prescribed drugs for people with bipolar disorder. On the other hand, psychiatrists have found that anti-depressants alone are not adequate to treat bipolar disorder. That’s because an anti-depressant can mask a manic episode or even shoot a bipolar patient into mania. On the medication side the appropriate treatment for bipolar patients involves an anti-depressant and a mood stabilizer. On the non-medication side it involves psychotherapy, cognitive-behavioral therapy, exercise, proper sleep and nutrition and helping the patient control his drinking if that is an issue.

After it was approved for treatment of bipolar disorder by the FDA in 1970 Lithium became the universal drug of choice to stabilize mood in bipolar I patients.  Lithium had a good safety record. It showed effectiveness in reducing the frequency and severity of manic episodes. It helped relieve depression in some bipolar I patients and reduced the suicide risk in bipolar patients. Lithium also helped manic-depressives control their drinking. It was considered, and still is considered, a good maintenance drug for people with bipolar I.

No drug is perfect. Lithium only works if the blood level is not too high or too low. Long term use can suppress thyroid function and cause kidney damage. Patients taking it are advised to drink 8-12 glasses of water a day and get their blood checked periodically to monitor lithium concentration, which can kill people if it gets too high. Long term use is also associated with mild cognitive impairment, weight gain and tremors.

There is no question that psychiatrists have moved in droves away from Lithium to anti-convulsants. Depakote is prescribed twice as often as Lithium for bipolar patients. As a group anti-convulsants also have significant side effects. Like Lithium, anti-convulsants can cause weight gain, cognitive impairment and tremors and like Lithium they can’t be taken by pregnant women because they cause birth defects. Personally, I’m not entirely clear why there has been this mass movement. It may have something to do with the availability of new drugs, wanting to be on the cutting edge and having drug reps swarm doctor’s offices to push the new drugs. Is this move from Lithium to anti-convulsants a good thing for patients? There are many psychiatrists who say yes.

On the other hand at least one very highly knowledgeable person says no. Dr. Ross Baldessarini is a professor of psychiatry and neuroscience at Harvard Medical School and director of the psychopharmacology program and the International Consortium for Bipolar Disorders Research at McLean Hospital. He knows that reducing risk of suicide is a major public health challenge, and that suicide rates in patients with bipolar disorder are among the highest of any diagnostic group. Three out of every one thousand people with bipolar disorder commit suicide, a rate twenty times higher than the rate in the general population. Dr. Baldessarini says, “Long-term use of lithium is the only treatment we have that is proven to reduce risk of suicides and life-threatening attempts.”

Now lets look a paper which came out in the July 27, 2010 issue of Neurology. A group of investigators led by Frank Anderson, M.D., of Berlin, Germany, wanted to ascertain the relative rise in the suicide risk caused by between different classes of anti-seizure drugs. The reviewed data on 44,300 patients in the United Kingdom who had taken at least one prescription for an epilepsy drug between 1989 and 2005. Participants were followed for an average of 5.5 years. Out of the entire group 453 had harmed themselves or attempted suicide; and 78 died at the time of or within four weeks of the initial attempt. The 453 people were compared to 8,962 sex and age matched peers in the larger group who had not harmed themselves or attempted suicide.

The investigators found that people currently using newer anti-convulsants like Topomax, Keppra, Sabril or Gabatril were three times more likely to harm themselves or attempt suicide than those who were not currently taking any epilepsy drugs. They did not find a statistically significant increase in the risk of suicide from taking Depakote, Tegretol, Dilantin, Neurontin or Lamictal (a drug which carries a small but scary risk of incurring a bizarre, fatal condition that causes all of your skin to slough off). Their finding that Depakote did not increase depression or raise the risk of suicide is a good thing since so many bipolar patients are taking it.

So where does this leave us? For mood stabilization most Bipolar I patients are taking Lithium (which lowers the suicide rate) or Depakote (which the study by Dr. Anderson said doesn’t raise it). For those Bipolar I patients taking Topomax, Keppra,  Sabril or Gabatril, I suggest you have a talk with your doctor and tell him about the article. Most Bipolar II patients are taking an anti-convulsant or anti-psychotic for mood stabilization. These patients should also speak with their doctor, especially if they have been prescribed one of the three drugs highlighted by Dr. Anderson’s group. Although anti-psychotics appear to have good mood-stabilizing properties, as a group they tend to cause significant weight gain and increase in blood sugar with increased risk of diabetes. It’s very important to stay informed and to voice any concerns or complaints you have about medication side effects to your psychiatrist so he can assess them and work with you to make a medication adjustment in a safe, thoughtful manner.

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TRAIN YOUR BRAIN USING OPEN FOCUS EXERCISES TO DIFFUSE STRESS AND RELIEVE ANXIETY OR DEPRESSION

July 26th, 2010

The human brain is an electro-chemical organ which produces a small but measurable amount of electric current in the form of gamma, beta, alpha, delta and theta waves. Each wave type has a range of frequencies associated with different types of mental activities. The brain does not emit any one wave type in pure form. At any given moment it emits a mix of two or more wave types. The predominant wave type can vary s with the part of the brain being measured. EEG brain wave patterns vary depending on whether a person is awake and actively concentrating, awake and resting, falling asleep, in deep slow wave sleep or dream (REM) sleep; in a fearful, tense and fight-flight state; in a calm, meditative state; or in states of consciousness affected by such things as sexual arousal or consumption of alcohol or drugs. Mental illnesses and alcoholism show distinctive brain wave patterns.

Neuropsychologist Les Fehmi, Ph.D., is an expert in the link between brain waves and stress reduction. After doing his post-doctoral work at the UCLA Brain Research Institute, he became a pioneer in neurofeedback therapy. Neurofeedback is a method of helping individuals reduce stress levels and anxiety symptoms by gaining control over their central nervous system using EEG biofeedback. In 1969 Dr. Fehmi co-founded the Biofeedback Society of America which later became the Association for Applied Physiology and Biofeedback. During the 1970s Dr. Fehmi used neurofeedback on hundreds of patients. He had them sit at a desk wearing a headband with a nest of electrodes attached to their scalp while they watched their EEG displayed in real time on a screen. They were asked to control their brain waves without being told how to do so, since nobody quite knows how this can be done. If they did not make the desired changes they were notified by bleeping noises and flashes of light.

Dr. Fehmi’s approach to neurofeedback was twofold. First he wanted patients to learn to synchronize their brain waves across their entire brains, because the brain operates most efficiently, effectively and under the least stress when brain cells in different brain regions are firing together (synchronously) in the same wave pattern. Second he wanted his patients to reduce beta (the highest frequency, most energetic brain waves in the range of 13-50 hertz) and increase the amount of their alpha waves (in the range of 8-12 hertz). At the higher end of beta frequency people show great mental effort, high mental energy expenditure, anxiety and tensed muscles. A college student taking an important exam who does not know the material and a driver who blares his horn and screams angrily after being cut off are in high beta. In the alpha frequency people are in a relaxed but alert state where they can observe and deal with the world without intense effort. Meditation puts people in an alpha state. You can also move from beta to alpha by closing your eyes.

During the 1970s Dr. Fehmi noticed an interesting phenomenon while treating his patients. All of them went through a difficult break-in period using neurofeedback where no matter how hard they tried they could not get the results they wanted. They couldn’t synchronize their brain waves or reduce beta and increase alpha frequencies. It was only when they gave up and were on the verge of quitting the training that they succeeded. It was only when they concluded that no amount of trying would succeed and they let go of trying, that they effortlessly brought their brain waves under conscious control. Dr. Fehmi concluded that to be successful in neurofeedback his patients had to give up their effortful orientation to the task.

This led Dr. Fehmi to realize that the how of attention (how we pay attention to something) is much more important than the what (the content of our attention). He began taking physiological measurements of people attending in effortful (beta) and relaxed (alpha) fashion. He found that effortful attention triggers the sympathetic nervous system with the adrenalized fight-flight response and over-reactivity;  whereas relaxed attention triggers the parasympathetic nervous system which keeps people calm and at ease. Dr. Fehmi also found that people learn information more quickly, more accurately and with much less effort in a relaxed mode of attention. People who approach tasks in an effortful way have greater difficulty and progress more slowly.

After years of studying attention Dr. Fehmi came up with different categories of attention. Narrow focus refers involves intense effortful attention associated with high beta waves. A person using narrow focus shrinks the aperture of his attention to one object (be it a person, thing or  idea) while pushing all other objects into the background and excluding them from consciousness insofar as possible. Open focus refers to a diffuse form of attention in which the person’s aperture of attention is wide open. In open focus a person remains aware of the object he’s attending to, but he is  simultaneously aware of his internal sensations, feelings and ideas, the objects in his environment along with their sounds, sights and smells; and the space in, around and between external objects.

Objective focus refers to a state of scientific detachment from the object of attention which is looked at as a wholly separate and distinct entity. It is accompanied by a high degree of self-consciousness, analysis and judgment. Immersed focus refers to a form of attention in which the observer experiences the object of attention from within, yield to it and joins with it. It is accompanied by sensations of union, pleasure and love and marked by a loss of self-consciousness and judgment.

According to Dr. Fehmi the most prevalent form of attentional style in our society is the narrow-objective kind. It can manifest as an obsessive-compulsive focus on a psychological or environmental object or as a denial of and shift of attention away from such an object. This kind of attention limits our awareness and stimulates fear and anxiety by separating us from our inner guidance system (our sensations, feelings, emotions, and intuitions) and from other people. Lawyers engage in the narrow-objective style of attention nearly all the time. They frequently focus on ideas, words and word meanings to the exclusion of their own physical sensations and feelings and their inner sense of what others are feelings. Dr. Fehmi says that people who are stuck in this mode of attention show awkwardness, lack of smoothness and fluidity in dealing with others and a tendency toward anxiety, worry, panic and rigidity.

Narrow-objective attention is a creature of the left brain. Our cave dwelling ancestors used it when they were out hunting or foraging and they had to scan their environment with utmost vigilance and urgency to spot predators like saber tooth tigers. Children in our day learn to use narrow-objective attention when they are told to stop day dreaming, focus on their homework and prove to their parents and teachers that they know their academic material. This amps up their nervous system. As children or as adult lawyers we can get stuck in this amped up state of great cognitive intensity which rigidifies one’s thinking and one’s muscles. Open states of attention act as a gear shifter that can take us out of this mental and physiological state in which we are stuck in over-drive. They allow us to get the best performance out of our brains and feel so much better.
Although narrow-objective attention has its uses, the problem (says Dr. Fehmi) is that we are addicted to it and we use it in many situations where it is more of a hindrance than a help. Narrow-objective focus is useful when learning the parts of the human body, but not when figuring out why a patient is dizzy or depressed. Narrow-objective focus is  useful in learning the notes to a music score but not when playing your part during a symphony orchestra performance. Narrow-objective focus may have some use during  sexual foreplay but not when making love. The key is in developing attentional flexibility so you can make use of all forms of attention at the appropriate time. Developing this flexibility helps release the psycho-physiological stress stored up through habitual use of narrow-objective attention.

When we stop excluding parts of our experience, open up our focus and allow our attention to equally and simultaneously spread out, we experience a softening of goal-directed behavior, a release of energy and a greater sense of wellbeing. The addiction to narrow-objective focus causes us to miss out on many opportunities to use open-diffused and open-immersed attention which are associated with the right brain and which give us a broader big-picture view which sparks creativity, empathy and spirituality. When the right brain is engaged sensory experiences become more fresh, vivid,  captivating, and satisfying. Our brains were designed to be multi-modal, which means they were designed to take in and integrate information from all five senses. We learn best and enjoy life most when we use our minds in a multi-modal fashion. Dr. Fehmi says that a life lived with open focus takes us away from tension, rigidity, anxiety and fatigue to ease, flexibility, efficiency, energy, productivity, spontaneity and creativity.

So how do we get there? You can either seek a solution to your problems in the content of your lived experience (memories of the past), which Dr. Fehmi says won’t work, or you can change your style of attention to open focus. When patients come to Dr. Fehmi for help he can give them neurofeedback, open focus exercises or both. The neurofeedback route is more expensive and requires multiple visits to his office in Princeton, New Jersey, to use the EEG machine.

Patients using neurofeedback benefit by producing more alpha than beta all over the brain and by harmonizing their production of alpha so the various parts of their brain emit alpha in unison like a choir. This allows information to pass through the brain more rapidly, fluidly and completely and allows for the greatest possible integration of information. It enables thinkers, artists, musicians and athletes to reach their peak performance. If you want to try this therapy your insurance might cover it, for instance if the presenting complaint was headache or insomnia. If you can’t make it to Princeton where Dr. Fehmi’s Princeton Biofeedback Center is located, you can go to his website at www.openfocus.com to find links to people he has trained in various parts of the country.

Open focus exercise therapy is inexpensive and can be done at home or at the office behind closed doors. You can do it with a CD. In 2007 Dr. Fehmi came out with The Open Focus Brain published by Trumpeter Books. It contains a companion CD with open focus exercises as well as written exercises after each chapter. I have tried the open focus exercises on CD and found them quite helpful. They put me in the same relaxed, tranquil and mildly euphoric state of mind that meditation does. Like meditation these exercises give me renewed mental clarity and extra energy. Open focus exercises and meditation both involve learning to accept rather than fight one’s sensations, feelings and ideas. In his book Dr. Fehmi talks about curing pain by turning into it, rather than running from it and trying to push it away. Whether you allow the imagined physical space around your pain or the space of your awareness to enter it and fuse with it, either way it will dissolve. The same holds true for negative thoughts and fears.

Based on his work with many thousands of patients Dr. Fehmi says that open focus work can become second nature after you do the exercises enough, and it can not only reduce your stress and anxiety, but help you with self-realization. Chronic stress breeds depression, substance abuse, insomnia, fatigue and stress-related disorders like asthma, allergies, rashes and psycho-somatic pain syndromes. When these have been cleared up, and your brain is working in alpha and firing synchronously, you can expect to experience renewed energy, productivity, enhanced relationships and improved performance in your work, sports, leisure and artistic activities.

Although open focus work is compatible with, and can be done simultaneously with, meditation, I know from experience that some people who could benefit from both modalities are not going to become long term meditators. Why? Some people don’t like sitting for prolonged periods of time in silence in the hope of reducing stress, improving mental clarity and gaining wisdom and compassion. They find listening to their own interior mental chatter intolerable – or they complain of distracting noises, physical pain or discomfort, boredom, restlessness, frustration, lack of progress and a host of other problems. Meditation isn’t for everyone. For these people open focus could be a safe, drug-free method of reducing stress, anxiety and depression while enhancing their performance of and enjoyment of their work and other activities.

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EASE EYE MUSCLE TENSION – FEEL BETTER, SEE BETTER

July 24th, 2010
Lawyers, like other professionals, read a lot. For the vast majority of us reading is an effortful process which engages and tenses our eye muscles. According to John Medina, Ph.D., in order to recognize each word, we must first decode it visually by turning each letter into a picture and then putting all the individual letter-pictures together. We then have to remember what the word means, and this can vary depending on the context in which it is used in a given sentence. Now consider the fact that we are struggling to understand and accurately retain the meaning not just of sentences, but of whole pages of dry, technical and complex material when we read. On top of that much of the reading and writing we do is on a computer screen. Hours of watching words on a glowing screen tends to cause eye strain. The typical lawyer does not stop reading from his computer screen every hour to rest his eyes, walk around and stretch.
Neuropsychologist Les Fehmi, Ph.D. is an expert on attentional styles. For forty years he has spent his career researching how people pay attention, and the consequences of their attentional style. Dr. Fehmi says the most prevalent form of attention in our society is the narrow kind. By narrow he means we select out one object to really focus on and put in the foreground of consciousness while pushing all other objects away and into the background of our consciousness. For example when a lawyer is reading or writing on a computer screen he is rigidly focusing on the content of the screen while expending energy to exclude every other internal sensation and external perception.
To get his brief done before his lunch appointment he ignores the growling in his empty stomach, the sounds of cars honking, ringing phones and voices in conversation from other cubicles, and the fear in his gut that he’s going to lose the hearing and lose the client or his job. To stay in narrow focus he may be forcibly twisting the flesh on his forehead or driving the bottom of one foot into the floor with his calf contracted without even noticing. His attention is riveted to the words on the screen to the point where he’s not diffusing any of his attention to his internal or external world.
Dr. Fehmi says narrow focus is a rigid form of attention which requires a great deal of mental energy. In our ancestors it was associated with scanning of the environment for survival threats like saber tooth tigers and was associated with fear. This form of attention triggers the release of adrenalin, tenses the muscles and traps fear in the muscles. Much of the tension is stored in the eye muscles. Chronic tension in the eye muscles from narrow attention can cause vision restriction,  eye twitching and headaches.
Dr. Fehmi recommends two different strategies for easing the tension in your eye muscles. One is to take breaks to soothe your eyes and release the tension. There are specific eye muscle massages you can do to release the tension. You can find these on the Internet or consult an optometrist. There is a Tibetan Buddhist form of yoga called Kum-Nye which has a number of different self-massages for the eyes. These involve using gentle pressure above and below the eyes in the eye sockets, the forehead and cheek bone areas.
The second method he recommends is to open up and diffuse your mental focus to take in everything in your internal and external world and the space around those objects.  This is called open focus. It stimulates the parasympathetic nervous system, relaxes your muscles and allows for effortless concentration and activity. Dr. Fehmi has been working on Open Focus Therapy for the past forty years. Using this therapy he has helped children and college students with reading disorders, ADHD and ADD. In my next blog article I will discuss the details of open focus attentional retraining. The benefits of open focus go way behind relaxing the eyes and include relief of anxiety and depression.

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LESSONS ABOUT RACIAL BIAS FROM WASHINGTON, D.C.

July 23rd, 2010
En route to New Jersey to celebrate my beloved father’s 85th birthday, my family and I visited Washington, D.C. so we could show our son Elliott the museums and monuments that capture the history of our country. Among the places we saw were the Lincoln Memorial and the Holocaust Museum. I was profoundly affected by their exhibits which portray the best (Lincoln) and the worst (Hitler) in human potential along with two views of the ideal society at the extreme ends of the philosophical spectrum.
When Lincoln read the declaration in the Declaration of Independence that all men are created equal and all have the rights to life, liberty and the pursuit of happiness, he had no doubt that this declaration applied with equal force to white people and people of color. He was aghast that white citizens in the Southern United States reserved these rights to themselves while forcing people of color to engage in hard labor without pay while depriving them of education and subjecting them to harsh physical punishment if they refused to go along. He saw slavery as the greatest conceivable contradiction to the declaration of belief that all men are equal.
Lincoln wrote to Joshua Speed in 1855: How can any one who abhors the oppression of Negroes, be in favor of degrading classes of white people? Our progress in degeneracy appears to me to be pretty rapid. As a nation, we began by declaring that “all men are created equal.” We now practically read it “all men are created equal, except Negroes.” When the Know-Nothings (a nativist, anti-immigrant group) get control, it will read “all men are created equal, except Negroes, and foreigners, and Catholics.
Lincoln saw the creation of the United States as a compact by the States to form an unbreakable union to establish a way of life in which all men (without any exception based on skin color) had liberty and all were treated equally. He viewed secession by any State as an illegal act. Lincoln firmly believed the federal government had the responsibility and the power to stop any State from taking the illegal path of secession to preserve slavery. Prior to the outbreak of the Civil War he begged the Southern States to remain in the union and refrain from seceding but to no avail. When they did secede he had the integrity and the courage to wage war to preserve the union.
When I left the Lincoln Memorial and looked around I saw people of all skin colors and national origins mixing together, snapping pictures, smiling and laughing.  It occurred to me that if Lincoln had not bravely asserted his position that all men are equal means that ALL men are equal, I would be living in a very different world, one a bit closer to insane world envisioned by Hitler.
My journey through the Holocaust Museum was an immersion into the mind of a person who attempted to re-create the world along racist lines by starting a world war which ended up causing the deaths of 50 million people. There is no doubt that Hitler was motivated by a lust for power and that the objective for much of his robbing, enslaving, killing, and looting the corpses of others, was to acquire the money and labor he needed to mount attacks on other countries and achieve world domination. But there was another aspect to the unparalleled brutality and destructiveness of his campaign, and that was racism.
Hitler preached that the Aryan race was mentally and physically superior to all other races and therefore entitled to rule the world and have all its wealth and treasures at its disposal. He preached that other races were mentally and physically inferior, morally degenerate and even subhuman. He employed so called scientists to set up institutes and museums to propagate his racist views by instructing the populace on the inferiority of non-Aryan races using skulls, skull measurements, photographs, pseudo-evolutionary charts and other exhibits. His scientists selected photographs that portrayed Germans intelligent, noble and heroic while portraying Jews, Asians, Pacific Islanders, Native Americans, Africans and other groups in the most unflattering light.
There can be no doubt that Hitler’s racist hatred and genocidal plans focused mainly on the Jewish people, yet the Holocaust Museum shows he hated, attacked and killed other groups including Gypsies, gays and lesbians, Poles, Catholics, and the disabled. Lincoln’s point, in his letter to Joshua Speed in 1855, applies here. Once you define yourself as belonging to a group of people which is superior to another group of people, it doesn’t take long for you to add to the list of inferior groups which you are entitled to exclude or mistreat.
As I went through the Holocaust Museum I boarded a windowless rail car that was used to transport Jews to concentration camps. I learned these cars were stuffed so full of people there was no room to sit down. There were old people, children and pregnant women in these cars. There were no sanitation facilities. The cars would sit for hours or even days at a complete stop in boiling heat or sub-freezing temperatures. Most people in these cars died and the living had to endure being in contact with the corpses. I saw other bone chilling exhibits including a pile of thousands of shoes and a table that was used to extract the gold fillings from the teeth of corpses at concentration camps. Thank goodness the exhibits finally changed as they began to focus on the Allied victory, the liberation of the camps, the resettlement of the survivors, the punishment of some of the Nazis and so forth.
As I left the museum and looked around me I was incredibly thankful for the bravery, courage and persistence of the Allied forces who defeated Hitler. I mused that if we had lost our country would be involuntarily serving Germany and I would have been placed into a concentration camp. I also thought about the insanity of dividing up all human beings along racial lines, deciding their worth on those lines, and making life and death decisions about their continued existence based on inclusion in racial groups. In an earlier blog article I discussed an excellent book on racism called Human Kinds. This book showed that any effort to classify people based on race is non-scientific since race is a concept in our minds not an objective reality. Furthermore, no one “race” contains people who are strictly identical with regard to their genes, national origins, history, culture, language, politics, religion, temperament, lifestyle, etc.
What does all this have to do with lawyers? As lawyers we come into contact with all sorts of people ever day. Depending on our mind set a person’s race can or cannot come into play when we make hiring and firing decisions, partnership decisions and work assignments. When we assess the credibility of a witness or an expert. When we adopt a certain tone of voice and manner while questioning a witness, addressing a judge or addressing another lawyer. When we select juries by using our peremptory challenges to retain some people and exclude others.
I am glad that I went to Washington, D.C. and saw the Lincoln Memorial and the Holocaust Museum because they sensitized me to the issue of race. While I have always made a conscious choice to exclude race in how I deal with people, I know from books like Human Kinds that race can creep into my thinking and behavior unconsciously and that I must remain vigilant in detecting it and defeating it. The same is true of all of us.
Let us all remember the example of Abraham Lincoln and his determination to eradicate slavery. Let us all be vigilant in screening out race from how we think about, feel about and act towards others so that we treat others as unique individuals who are every bit as entitled as we are to life, liberty and the pursuit of happiness.

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LAWYERS WELLBEING BLOG ON VACATION

July 11th, 2010

Harvey Hyman will be on the East Coast visiting family so no new blog articles will be posted until he returns on July 23, 2010.  I wish all my readers safety, health, happiness, and ease.  For blog readers who have not visited my website or purchased my book, please take a look at www.lawyerswellbeing.com

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USE GREAT CAUTION BEFORE STARTING DAILY ASPIRIN THERAPY

July 11th, 2010
TV advertisements, magazine articles and over-the-fence chats between neighbors about the benefits of aspirin have led some people to take an aspirin everyday because they think it will protect them from a heart attack or stroke. Some people take aspirin everyday for headaches or for life’s aches and pains. Since the daily use of aspirin carries some very serious health risks that people may not be aware of, it’s important to get the facts.
Heart attacks result from the stoppage of blood flow to the heart when a coronary artery becomes plugged from a blood clot (known as a thromboembolism), from an embolism made of fatty plaque or from arterial spasm. There are two kinds of strokes. Occlusive strokes result from thromboembolic blockage of an artery supplying the brain. Hemorrhagic strokes result from bleeding within the brain due to rupture of a brain blood vessel. Aspirin is effective at reducing blood clot formation within arteries. Thus aspirin reduces the risk of thromboembolic heart attacks and occlusive strokes but not hemorrhagic strokes. Taking daily aspirin can actually increase the risk of hemorrhagic strokes.
According to the Mayo Clinic daily aspirin therapy can prevent a first or second heart attack and reduce the risk of heart disease in men of all ages. The Mayo Clinic says daily aspirin therapy can prevent a first stroke, prevent a second heart attack and reduce the risk of heart disease in women under age 65. For women over age 65 it can prevent a first and second heart attack, prevent a first stroke and reduce the risk of heart disease. The safest daily dose is between 75 mg and 81 mg (baby aspirin). In some cases your doctor may recommend a higher dose up to 325 mg per day.
Aspirin therapy is associated with a great many health risks including internal bleeding. The Mayo Clinic recommends that you refrain from aspirin therapy if you have a bleeding or clotting disorder, asthma, stomach ulcers or heart failure. For whom does the Mayo Clinic recommend daily aspirin therapy? For those people who have already had a heart attack or stroke; and for those people who have  strong risk factors for a heart attack or stroke.
Risk factors for blockage of arteries going to the heart or brain from blood clot formation include: smoking tobacco; high blood pressure (systolic pressure at or over 140 mm Hg or diastolic pressure at or over 90 mm Hg); total cholesterol level at or over 240 mg/dL; low density (bad) cholesterol level at or over 130 mg/dL; sedentary life style without exercise; diabetes; chronic stress; having two or more alcoholic drinks per day if you’re a man and one or more drinks a day if you’re a woman; and a family history of heart attacks or strokes.
What are the chief health risks of daily aspirin therapy? The Mayo Clinic says they include hemorrhagic stroke (bleeding stroke); gastrointestinal bleeding; allergic reaction; and ringing in the ears (tinnitus) with hearing loss. Since aspirin can upset the stomach and thin the blood they warn against having more than one drink a day if you’re a woman and more than two if you’re a man. Bleeding risk is increased in patients taking a daily aspirin if they’re already taking a blood thinner, if they use NSAIDs or corticosteroids regularly or if they take certain supplements like Sanshen, Dong quai, Evening primrose oil; Gingko biloba; Policosanol; and Willow bark.
In May 2010 Dr. Andrew Hart of the University of East Anglia presented research at the Digestive Disease Week conference in New Orleans indicating that regular use of aspirin for one year or more increases the risk of developing Crohn’s Disease by five times. Crohn’s Disease involves inflammation and swelling of any part of the digestive system, but most often the lower section of the small intestine called the ileum. It can be debilitating because of chronic abdominal pain, diarrhea, rectal bleeding and weight loss. Crohn’s Disease can require lifelong medication. Dr. Hart’s research group followed 200,000 volunteers aged 30-74 in the UK, Sweden, Denmark, Germany and Italy who had been recruited for a European study on the link between cancer and nutrition. Although all volunteers were initially well, a small number had developed Crohn’s Disease by 2004. When study participants were questioned about their use of aspirin, it turned out that the regular aspirin users were five times more likely to be in the group that developed Crohn’s Disease.
The take home message is that while daily aspirin therapy can be very beneficial, even life saving, in preventing heart attacks and occlusive strokes in some people, it does carry some very significant health risks. No one should start aspirin therapy without their doctor’s approval after reviewing the potential benefits and risks. Anyone taking a daily aspirin should check in with their doctor if they notice symptoms of gastrointestinal inflammation such as abdominal pain, diarrhea or rectal bleeding.

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USING JASMINE FRAGRANCE INSTEAD OF DRUGS TO INDUCE SLEEP

July 10th, 2010
Difficulty falling asleep is a worldwide problem and the use of drugs to induce sleep is commonplace. In the U.S. tens of millions of people use prescription drugs to depress the central nervous system and fall asleep. The two main categories are selective GABA agonists without benzodiazepines such as Ambien, Lunesta and Sonata and benzodiazepines (anti-anxiety drugs) such as Valium, Xanax, Klonopin, Ativan, Restoril and Halcion. Benzodiazepines are also known as benzos or benzies. Both classes of drugs activate the GABA system in the posterior hypothalamus of the brain. GABA is the main inhibitory neurotransmitter in the human brain which acts to calm, relax and quiet the brain.
Not all Americans use these drugs like Ambien of Valium. Some use anti-depressants like Trazodone, anti-convulsants like Neurontin; pain medications like Darvocet; muscle relaxants like Flexeril; or over-the-counter anti-histamines like Nytol, Tylenol PM or Unisom. Many people consume alcohol to get to bed, and there are some who get hooked on cough syrup containing alcohol. Prescription drugs, alcohol and over-the-counter drugs all have their side effects. To varying degrees they pose a risk of drug tolerance (needing a higher dose to get the same effect), drug dependence and withdrawal symptoms.
The non-benzodiazepines can cause dry mouth, drowsiness, feeling drugged and dizziness. The most common side effects of benzodiazepines are related to their sedating and muscle-relaxing action. They include drowsiness, dizziness and decreased alertness and concentration. They can produce incoordination with injury-falls and traffic accidents. Decreased libido and erection problems are a common side effect. They can cause depression. Less common side effects include nausea and changes in appetite, blurred vision, confusion, euphoria, depersonalization and nightmares. Cases of liver toxicity have been described but are very rare.
In Germany 20% of adults take benzodiazepines drugs to fall asleep. These drugs are highly addictive and although they are only supposed to be taken for no more 2-4 weeks, many people take them for years. Long term use of benzodiazepines over a period of years are associated with a general deterioration in physical and mental health, including cognitive impairments, behavioral problems, anxiety and depression, loss of sex drive, agoraphobia and social phobia, an altered perception of self and environment, and an inability to experience or express feelings. The most frequent withdrawal symptoms are insomnia, gastric problems, tremors, agitation, muscle spasms, and fearfulness. Less common effects are irritability, sweating, depression, psychosis, suicidal behavior, seizures, and delirium tremors. Severe symptoms usually result as a result of abrupt or rapid withdrawal, so gradual reduction is recommended.
Recently a team of researchers in Germany (Hanns Hatt of the Ruhr University in Bochum and Olga Sergeeva and Helmut Hass of the Heinrich Heine University in Dusseldolf) tested hundreds of fragrances to find a non-harmful substitute for benzodiazepines to induce sleep. They wanted to find out which fragrances, if any, could match the potency of benzodiazepines in activating GABA receptors in the posterior hypothalamus of mice. Their published results in the online July 2010 issue of the Journal of Biological Chemistry show that the fragrance of jasmine is highly effective in sleep induction. The jasmine fragrance vertacetal-coeur and its chemical variation (PI24513) were able to increase the GABA effect in mice by more than five times and act as strongly as benzodiazepines. This was the case whether the fragrance was injected or inhaled in a plexiglass cage. The mice exposed to the fragrance became extremely tranquil and their brains showed electrophysiologic evidence of the sleep cycle. The researchers were granted a patent for their discovery.
Thus there appears to be a scientific basis for aromatherapy with regard to inducing sleep, and this holds out some promise that people who are now dependent on drugs to fall asleep may be able to use a side-effect free jasmine fragrance instead.

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