Tag Archives: mental health

A Summary and Response to Scrupulosity in Patients with OCD published in Journal of Anxiety Disorders

Introduction

Obsessive-Compulsive Disorder (OCD) is a nasty beast. I find the scrupulous (religious) elements the most ugly b/c unlike the general OCD symptoms I have a much harder time distinguishing which are “legitimate” and which are “illegitimate.” That is, my brain is being ridiculous when I feel the need to wash my hands over and over again…I have a much harder time knowing if my brain is being ridiculous when it constantly urges me to spend more time with God.

Person washing his hands
Person washing his hands (Photo credit: Wikipedia)

I already take medication for OCD – and it helps significantly. I don’t wash my hands too much, turn my car around to check if maybe I accidentally ran someone over without noticing, or so on any more (okay, so I do regularly check thoroughly via my mirrors after backing out of my driveway…), but the scrupulous symptoms, while less intense (they nearly crippled me), are still present.

I have spent significant time in counseling and see a Cognitive Behavioral Therapist currently. I’ve read many books and articles on the topic and am oftentimes one folks who are struggling with OCD or scrupulosity will engage in conversation for assistance.

Lately I’ve been feeling the pressure of the scrupulous more thoroughly and have been trying to battle it off. Part of this includes reading about OCD. Learning about OCD helps soothe me and also gives me ideas for new methods of battling my OCD. In this case I read Elizabeth A. Nelson, Jonathan S. Abramowitz, Stephen P. Whiteside, and Brett J. Deacon’s article “Scrupulosity in Patients with Obsessive-Compulsive Disorder: Relationship to Clinical and Cognitive Phenomena.” (Journal of Anxiety Disorders, 2006, pp. 1071-1086).

It is a fairly technical article and I am not trained in statistics and other forms of research analysis, so some portions of the report where undecipherable to me…but I figured I’d share what I was able to distill from the report along with my commentary when I had such.

Summary and Response

  • “The themes of OCD vary widely…with one of the more recalcitrant presentations involving obsessions and compulsions concerned with religion…” – pg. 1072.
    • I’m glad to hear it isn’t just inside my head that scrupulosity is difficult to treat.
  • “Religious OCD symptoms…typically involve ‘seeing sin where there is none’ and are frequently focused on minor details of the person’s religion, to the exclusion of more important areas.” – pg. 1072.
    • I think I am much better at this now than previously, but it is very easy to get tied up in small details and anxiety which prevents one from loving others. The principle that I am to love to the maximum has been helpful to me in setting aside anxiety and being willing to wade into situations where I know I will fail (sin).[1]
  • “Examining the content of obsessions among 425 individuals with OCD, Foa and Kozak (1995) found religion to be the fifth most common theme, with 5.9% of patients endorsing it as a primary obsessional symptom. Antony, Downie, and Swinson (1998) found that 24.2% of a sample of 182 adults and adolescents with OCD reported obsessions having to do with religion (not necessarily their primary obsession).” – pg. 1072.
  • “Previous research suggests that a patient’s religious denomination and strength of religiosity can influence his or her OCD symptoms…and clinical observations indicate that scrupulosity is often inadvertently reinforced by the teachings of the individuals religion.” – pg. 1072.
    • I have found this to be true in my own experience. When I have been in settings which emphasize my part, my symptoms flare up exceedingly whereas settings which emphasize God’s sovereignty and grace oftentimes relieve symptoms.
    • I read grace books on an almost continuous basis (e.g. Rutland, Lucado), as I have a tendency to quickly fall back into performance mode.
  • “Scrupulosity, with a focus on morality, is also mentioned in DSM-IV-TR as a symptom of obsessive-compulsive personality disorder (OCPD). However, whereas the thoughts and doubts pertaining to morality are experienced as unwanted and unwelcome (i.e., ‘ego-dystonic’) in OCD, they are experienced as consistent with the person’s world view (i.e., ‘ego-sytonic’) in OCPD…In contrast, the scrupulous ideation in OCPD (a) does not evoke anxiety or fear, (b) is not subjectively resisted, and (c) is not associated with violent and sexual obsessions.” – pg. 1072.
    • This is a footnote at the bottom of the page, but I disagree with it. I would suggest that individuals with OCPD, at least in my limited experience, may not be internally aware of their distress, but are in fact suffering significant distress. I think I could have been classified at one juncture as OCPD but at some definite point in time (during my college years) I experienced a ‘breakthrough’ which provided insight into the underlying anxiety and control, allowing me to become ‘OCD’ rather than ‘OCPD.’ The older one becomes with OCPD, the less possible I imagine it is to transition into OCD, b/c it involves admitting that much of what one has done and said over the last x number of years was of no or negative consequence. I was young and did not have much to look back on and admit was a wash.
  • “Contemporary cognitive-behavioral models of OCD implicate specific cognitive phenomena in the development and maintenance of the disorder. These cognitions include: (a) overestimation of threat (the belief that negative events are especially likely and would be especially awful); (b) inflated responsibility (the belief that one has the power to cause, and/or the duty to prevent, negative outcomes); (c) overimportance of intrusive thoughts (the belief that the mere presence of a thought indicates that the thought is significant); (d) the need to control intrusive thoughts (the belief that complete control over one’s mental processes is both necessary and possible); (e) perfectionism (the belief that mistakes and imperfection are intolerable); and (f) intolerance of uncertainty (the idea that it is important to be 100% certain that negative outcomes will not occur (Frost & Steketee, 2002).” – pg. 1073.
  • ” The essential tenet of cognitive-behavioral models…is that OCD develops when unpleasant, yet harmless, intrusive thoughts, doubts, impulses, and images are misinterpreted along the lines of the cognitive factors described above. This misappraisal evokes anxiety and motivates efforts to reduce this anxiety via neutralizing behavior (e.g., rituals) which is reinforced by the immediate (albeit temporary) reduction in distress it engenders…” – pg. 1073.
  • They used a number of different tools to analyze symptom severity, etc. Some I was familiar with, some I’d like to look into further. These included the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Obsessive-Compulsive Inventory Revised (OCI-R), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory-Trait version, Form Y (STAI-T), Penn Inventory of Scrupulosity (PIOS), Interpretation of Intrusions Inventory (III), Intolerance of Uncertainty Scale (IUS), and Mini International Neuropsychiatric Interview (MINI).
  • “Post hoc comparisons…revealed that Protestant patients…scored significantly higher on the PIOS than did patients with no religious affiliation…but not significantly higher…than did Catholic patients…” – pg. 1079.
  • “When we computed similar correlations for Catholic and Protestant patients separately, we found no significant relationships between PIOS score and strength of religious devotion in either of these groups.” – pg. 1079.
    • Essentially, one’s religious fervency is not correlated with the intensity of the symptoms, if I am understanding this correctly. Thus an individual barely committed to Christianity and an individual with a strong, life-long commitment may experience similar symptoms with similar severity. I would consider this a significant indicator for underlying biological/chemical/neurological processes (something which isn’t at issue here, but which is still a topic of discussion within Christian counseling circles).
  • “As expected, the OCI-R obsessing subscale significantly predicted scores on the PIOS.” – pg. 1080.
    • If I understand this correctly, one can predict scores regarding scrupulosity significantly using a more general OCD inventory that evaluates the obsessive nature of an individuals OCD.”
  • “Our data indicate that scrupulosity symptoms are present in each presentation of OCD. Although, as expected, patients suffering primarily with severe unacceptable obsessional thoughts (i.e., religious, violent, and sexual obsessions) evidenced greater levels of scrupulosity compared to those with primary contamination symptoms.” –  pg. 1081.
    • I’d like some clarification on the first sentence above. Are the authors saying that every individual with OCD has some scrupulosity or that for each type of OCD symptoms (e.g. hand washing versus counting) there are examples of individuals with scrupulous behavior – I tend to think the latter.
  • “Thus, even if religious obsessions are not associated with especially high frequency, interference in functioning, difficulty with resistance or control (i.e., the symptom parameters assessed by the Y-BOCS), these phenomena might represent a particularly distressing presentation of OCD.” – pg. 1082.
    • If I’m understanding this correctly, the frequency with which obsessions occur are not more with scrupulosity than seen in OCD generally, but they can be much more distressing to the sufferer than general OCD. I would agree with this.
  • “In support of our second hypothesis, scrupulosity was moderately associated with multiple cognitive biases believed to underlie the development of obsessional symptoms, including moral TAF, overestimates of the importance of and need to control intrusive thoughts, and inflated perceptions of responsibility.” – pg. 1082.
    • In other words, scrupulous sufferers are more likely to have poor cognitive patterns regarding the reality of their responsibility for their thoughts but they do not suffer (more frequently) poor cognitive patterns regarding the power of their thoughts to injure others.
  • “In an effort to reduce obsessional distress, individuals engage in compulsive (neutralizing) behaviors such as excessive prayer, confession, and checking for reassurance from religious authorities, among other strategies.” – pg. 1083.
  • “Research indicates that exposure and response prevention (ERP) is the most effective treatment for OCD (Kozak & Coles, 2005a), although many OCD patients with scrupulosity have difficulty accepting and adhering to ERP because it involves directly confronting situations and thoughts that are perceived to be sinful.” – pg. 1083.
    • Yup, that is a real problem…
  • “Nevertheless, we speculate that some CT techniques have relevance for facilitating ERP in cases of scrupulosity. For instance, patients could be taught that everyone sometimes experiences unwanted (morally repugnant) thoughts. The therapist could also arrange a meeting between the patient and a clergy member to disconfirm the idea that the occurrence of intrusive and unwanted thoughts (as opposed to deliberately thinking such thoughts) is equivalent to committing sinful behavior.” – pg. 1083-4.
    • I’d agree with this. Normalizing intrusive thoughts is important and helping an individual understand the difference between undesired and intentional immoral thoughts is also important.
    • I think that these unwanted thoughts are still ‘sin’ – but I would suggest that they are outside the control of the individual within this lifetime. An emphasis should be placed on the generosity of God’s grace and the petty God one creates when beating oneself up for unwanted thoughts.
  • The authors seem to suggest that ERP is still a way forward, once cognitive training has occurred (pg. 1084). I agree that ERP is an option, but I’m concerned about whether there is enough of an understanding of the importance of not overriding the morals of the individual in an attempt to cure – e.g. showing an individual who struggles with impure sexual thoughts pornography. This is an unacceptable solution within the faith community. We need another way forward…and energies placed into ERP that requires an individual to compromise on legitimate moral beliefs will not be that way.

Concluding Thoughts

I’m thankful to Nelson, Abramowitz, Whiteside, and Deacon for their careful research on scrupulosity. I applaud their commitment and dedication.

I’m thinking about (and hoping others suffering scrupulosity will do the same) what sort of therapeutic process could be utilized to treat scrupulosity that would not involve ERP procedures that would encourage actions considered immoral by the faith community.[2]

A few ways in which I have attempted to battle scrupulosity without engaging in this form of ERP therapy is:

  • Looking for my “secular” OCD and battling that. e.g., focusing on my vocal ticks (still have ’em), checking doors, and looking for people I ran over. Since they are all driven by the same underlying brain processes, I figure working on one should help relieve others…
  • Reading constantly a diet of materials which counter my brain’s natural ways of thinking and which encourage me to understand God as bigger and more important than me – items which while affirmed by the scrupulous oftentimes fail to take root in our hearts (at least in mine).
  1. [1]I can be quite a good person by myself, but being around human beings is difficult. :) At times I would isolate myself to avoid sinning.
  2. [2]In other words, even if the individual accepts the procedures as necessary, I think this is not a road forward, as the larger faith community cannot approve of these measures.

Surviving the Darkness: A Crash Course in Muddling Through Anxiety, Depression, and So On.

Introduction

[I originally published this post in April of 2013. Since then it has undergone a few minor revisions. Today I am doing a more extensive review – rephrasing things that might have been obtuse and sometimes expanding upon what I have said in order to clarify  certain topics. Additionally I have added an additional resources section which includes links to other resources I have created since 2013 for those in torment.]

A painting with Job sitting naked in the dirt.When was the first time my life ground to a halt, anxiety slammed me to the ground, and hope disappeared like the stars from the sky on a stormy night? I don’t know. The first time I can remember I was five.

Sometimes it has been episodes – intense, short-lived. Other times it has been prolonged, desperate, hell-fire-is-burning-in-my-brain suffering. Oftentimes it is a mixture of both – the fire that doesn’t go out and the worms that never die punctuated by times of absolute torment when death seems like my best friend and I wish it would embrace me and take me home.

I’ve spent all of my conscious life struggling with an assortment of mental illnesses – OCD and Depression being two of the most vicious. I’ve read a lot of books, been through a lot of counseling, taken a lot of medications – and I still do all these things. I’m not a mental health expert – but I have been through the ringer a few times. I try to document what I have experienced and learned in a systematic way – usually on one of my other sites OCD Dave.

Today I’d like to talk a bit about when you are in the midst of it. I mean when it goes from inconvenient, annoying, painful, to life-stopping, productivity killing, death-wish inducing. I can’t promise you that anything that works for me will work for you…and some of this is certainly not “best practices” from the medical establishment – but it is the best way I have learned to cope thus far…So, for what it’s worth, here is what I’ve learned about going through the darkness.

Clarifying Parameters

[I don’t like this section. Not because I don’t think it is important, but because I think it is so important. I have been unable to speak what needs to be said here in a way I feel is strong enough, persuasive enough. For the time being I capitulate to my inability, thankfully, there is someone else who has written exceedingly well on this topic – Peter D. Kramer. If you doubt that mental illness exists, that is a valid type of illness, etc. I would humbly urge you to read his amazing book, Against Depression.]

There are different kinds of mental illness. Some of us get ill because situations in our life are horrible (situational or environmental illness). Remove the situation (via passage of time, geography, physical intervention, legal action, etc.) and we get better. This is probably the most common form of the illness. Even though the illness is situational or environmental and thus in theoretically of a temporary nature, if the situation/environment never changes, it becomes in experience a permanental illness.  I’ll explain why I use the term “illness” to describe something caused by a situation a little bit later.

Then there is mental illness which comes about at a specific period of one’s life[1] with no known cause.[2] We are okay one day and the next we fall into a deep hole of depression or anxiety. What happened? With medication, counseling, and/or time we come out of the illness – it is limited in duration. This is probably the second most common form of the illness.

The last form, and the least prevalent, is chronic. It oftentimes begins in childhood and the prognosis for full recovery is dim and distant. Others may get better, but our illness stays the same. It gets worse when it likes and a little better when it likes. On occasion we can even feel “normal” – but that comes and goes without rhyme or reason.

This article is meant to be of assistance to anyone in the midst of the darkness from any of these types of illness – but it is especially focused on the last group – of which I am a part.

Is It Really An Illness?

All forms of mental illness are truly legitimate illness in the sense that the normal functioning of the body has stopped and a dysfunctional operation has begun. This is usually what we mean by illness, is it not? That for some reason the body – due to internal or external factors – has stopped functioning correctly?

But what about situational illness? Can that truly be an illness? Isn’t it the situation? Well, it is the situation – like black lung disease is situational to miners. While the situation may be the cause, this doesn’t reduce the severity of the physiological effects, nor should we assume that the individual in that situation is independently capable of removing themselves from the situation any more than many individuals working in toxic environments are capable of simply picking up and moving to a different location and taking a different job and making a different life.

I know that we can affect our body chemistry through our surroundings, our actions, our thoughts – but we must also acknowledge that our body chemistry influences these same surroundings, actions, thoughts. If I am lacking in certain brain chemicals I will not feel the desire to enter into certain good situations (e.g. relational interactions), I will not have the energy to participate in certain good actions (e.g. exercise[3]), and I may find thinking certain good thoughts impossible.

If we think rationally about how all other illness works – why people have allergies, diabetes, heart disease, and so on – sometimes we can point some of the finger at the individual, but we usually point most of the finger at their biological makeup. It is no different with the mind.

When the Storm Hits

I think of my “episodes” as similar to an old-fashioned frigate sailing the open waters. When the storm rushes in, the waves grow high, and the lightning snaps across the sky. The captain orders the sail taken down, all the hatches fashioned shut, and the crew below decks. Let the storm whip around as it may, there is nothing that can be done until the storm passes.

When the darkness hits with mental illness – the real depths of the abyss – there is no imminent escape. Sure, we can get counseling – but that isn’t going to make the pain go away right now. Sure, we can take medications – but most of them aren’t going to vanquish the darkness. Sure, we can practice our cognitive-behavioral techniques, but right now we can’t think and we can’t feel anything beyond the pain.

So what do we do? We batten down the hatches and wait the storm out. There is no use scurrying around the deck – let the storm roll over, let it take its course, and then when it passes, come out into the sun and survey the damage – make the repairs and prepare better for the future.

Medications

There are some medications which can provide relief in the midst of an attack. Accidentally and incidentally[4] I have discovered that steroids works this way for me. I hear Xanax (alprazolam) thrown around as a common medication used to treat these intense periods of darkness – but have never taken it myself. Klonopin (clonazepam) is another option – though, at least for me, this just makes me fall into a deep sleep (which is an enviable comparison to consciousness in this living hell). Talk to your doctor about your options – if you are a chronic sufferer, it might be worthwhile to have something when the storm hits so that your life doesn’t have to stop for quite as long…, people begin to wonder where we’ve gone and, especially family members, can mistakenly assume that they have done something wrong to cause this withdrawal.

For me, storms are oftentimes intense events lasting a day or longer and surrounded by other lesser storms. I recently [in 2013[ went through a two week period where halfway through was the worst storm, but for which there was an intense buildup and a prolonged winding down. I don’t know about you, but I really can’t afford to randomly have two weeks of my life vanish into thin air.

[So let’s take a quick journey through the methods I have found helpful…]

Passive Distraction

For recreation I oftentimes read – but that doesn’t work when I’m in the midst of a storm. I have no ability to read. I can speak the words, but my mind has no comprehension (and no interest in comprehending). I can read over and over, but the words are still lying like dead things on the floor. I need passive distraction – I need something that will distract me without requiring any effort on my part.

I keep a document called “Bad Day Movies.” It contains movies and TV shows that I REALLY want to see, usually that I’d have to pay to view (e.g. Amazon Instant Video), and that I don’t pursue until a bad day hits. When it hits I shell out a few bucks and slip into a passive dis-consciousness. Sometimes this will go on for hours – but heck, anything that takes my mind off the pain is better than sitting there as each agonizing minute passes.[5]

You might think I’d watch comedies during these times – but I don’t. Maybe that would work for you, but I don’t find many comedies funny even when I’m feeling well – when I’m in the darkness, comedies are inane boredom personified. I tend to watch intense thrillers, dramas, and sci-fi. One exception was Monk – which because it satirized my illness allowing me to laugh at it.

Conversation

Sometimes a good conversation can be cathartic. But it needs to be the right kind of conversation – and usually this will only work for a limited duration. Few people are really safe to talk to in this manner.[6] If you wonder why someone doesn’t come to you when they are struggling in this manner, it might be time to look at yourself and ask if you are safe for someone to be around in this time of crisis.

At these times, you can’t fix me, you can only travel with me. You can only walk for an hour or two alongside me and view from the outside the ravages of the storm within. This is helpful – but this is all that can be done. It is not that you are incapable, it is that I am incapable. You cannot remove me from this storm any more than you can make the sky shut its floodgates and the lightning turn off its brilliance. This is a situation which must be weathered, not escaped.[7]

Reading

I shared earlier that most reading is not useful, but there is some reading I find useful – though I must say that it is also of limited duration. Movies/TV I find to be the longest lasting distraction. Find the books that touch you and keep them around – then read them for as long as is useful during the midst of your suffering. For me, this is George MacDonald’s Diary of an Old Soul and Unspoken Sermons, Mark Rutland’s Streams of Mercy,[8] some of Max Lucado’s writings,  and a book like The Boy Who Couldn’t Stop Washing His Hands which is filled with case studies of people suffering like me which tells me I am not alone, I am not crazy, and I can survive.

Acceptance

We oftentimes begin by thrashing against the storm. We try to fight it, to shorten its duration or intensity – but I have found no way to shorten it. Sometimes it lifts suddenly, but there is no rhyme or reason. What causes it to lift one time will absolutely fail another. When something would have worked this time, nothing will work the next time.

It is a hard place to be, but in the midst of the storm we have to accept we are in the storm, batten down the hatches, and wait it out. I don’t mean that we should passively stay in this place forever – and we should seek proper medical treatment – but at some point we have done all that and it still comes on us…and, friend, I have simply found no way out. So get ready for hell and hold on – it is going to be a nasty ride – but every storm does end, every ride does stop, and sometime, somewhere, the storm will at least lull and you’ll have the opportunity to do something about your suffering, but right now – it is just here.[9]

Pacing

Alongside of acceptance is pacing. This is especially true for those of us who suffer from mental illness in a chronic fashion. We do not demand that a one-armed man be a good juggler, that an amputee win the Olympics, that a blind man read a book, that a deaf man critically analyze music – yet for some reason we still demand of ourselves productivity and speed as if we  had what others have – and we do not.

It is not that we have to be less than other people, but that we can be fully who we are if we pace ourselves. I do not enjoy my illness – but it has forced me to learn and grow in many uncomfortable ways – ways that (I think) allow me to maintain levels of productivity similar to others, but in my own way.

I know that if I spend x amount of time with people I will burn out for x * 3. I know other people can spend x amount with other people without issues. But I can’t. Maybe I should be able to, but I can’t. So, I pace myself. I do x – 1 and am able to do x – 1 for multiple days in a row, instead of doing x for one day and then 0 for multiple days thereafter.

I have to take naps.[10] I don’t like that. I don’t like that exhaustion washes over me like a tidal wave and my eyes shut against my will. But its okay, I do things at my pace and my life is different than others – but it works. Some days I sleep every x hours throughout the day and the night. Most people just go to bed (at night) and just stay awake (at day), but I don’t. I cycle between the two.

The latter I really try to avoid – but when it happens, it happens, and I accept it. In the past I wouldn’t, I’d fight it. I’d end up exhausted all the time and unable to accomplish anything.

Music

Over time I’ve collected a large selection of songs I find to be helpful when I am suffering. Depending on what sort of suffering I am in, I will listen to different kinds of music. There is the JJ Heller and Rich Mullins kind of suffering and then there is the Skillet and Thousand Foot Krutch kind of suffering – the latter I prefer at full blast (perhaps with ear protection) so that I can feel the bass pumping through my body. You can find more of the songs I listen to during times of suffering here.

Sleep

If sleep will come, take advantage of it. This is one nice thing about TV/movies, they oftentimes are passive enough to lull your body into sleepiness. When it comes, don’t refuse it. Let it carry you away, when you awake, go back to passive distraction if the burden remains.

Keep Searching

I’m not fatalistic, cynical, or pessimistic. I consider myself a realistic optimist. We cannot simply do nothing with our lives and I have never given up hope that someday, somewhere I might find the cure – or at least a partial cure – for what ails me. I continue to read, continue to try to improve my habits (my sleep routine, my schedule, my thoughts, my relationships, and so on). I don’t think we should ever give up hope – but we also can accept at times, as the sailors do, that the storm is upon us and there is nothing to be done right now but wait.

And God?

I’m a Christian – so what about God? If I was perfect I think I would find all of my joy in God in the midst of this suffering. I would need nothing else, but I am not perfect, I am human.

I don’t ask you to refuse Novocaine as the dentist drills out that rotten tooth or cuts through your flesh – yet I think that if we were perfect we would experience this even with joy in the midst of the suffering. Please don’t ask me to do something you can’t or won’t do yourself. I might not be bleeding on you at the moment, but my injuries are just as real.

For some, there may be comfort in prayer during this time. For me, there is agony. God knows I try, and after an hour has passed in my mind and a minute in reality I am exhausted, too weary for words. I cannot speak aright. I cannot feel aright. I cannot think aright.

I do find comfort in Scripture – though it must be select Scriptures.[11] At these times I do not need to know about God’s judgment, but about His love and grace. I do not need to know about victorious saints but about suffering servants who wrestle with the misery of incomprehension  of God’s purposes in this torment.

What About?

What I’ve described here may seem similar to the way others struggle through hard times – alcohol, drugs, illicit sex, gluttony. The last of these is a struggle for me during these dark times. What is the difference between what I advocate above? Do not all of them have the common factor that they do not rest on God alone? Yes, they do. But some forms of coping are less damaging than others.

Find legitimate ways of coping, or the illegitimate ones will find you.

Your Coping Strategies?

If you suffer from mental illness and have developed coping strategies when in the midst of the storm, I’d love to hear what they are and how they have helped you.

A Few More Resources

Since 2013 I have created several additional resources for those going through suffering. I compiled a number of paintings and images of suffering – most by great artists.

There is also a significant list of Scriptures expressing torment of individuals within Scripture towards God, the Scriptures of Suffering. Similar is the Scriptures for the Suffering which consists of Scriptures of comfort.

Note

[This is from original article in 2013] The timing of this article is coincidental to Matthew Warren’s suicide, but my heart goes out to the Warren family and all those who loved and knew Matthew. May God give you everything you need to continue through this dark time.

  1. [1]That is, a limited duration of time in one’s life, it can be at any time, just of limited duration.
  2. [2]This does not mean there is not an originating cause – environmental, situational, biological, etc., just that we have been unable to connect the dots…and we should be wary of too quickly connecting the dots, the easiest explanation is not always the right one.
  3. [3]BTW, I’ve tried this…and at least for me, there was no appreciable difference in mood. Now I have chronic issues with my legs that make it pretty much impossible to do what I used to do – a lot of biking. I also have experienced some of the most intense forms of the illnesses while working manual labor jobs – such as a crew member commercial fishing for salmon.
  4. [4]When I’ve suffered some sort of systemic over-reaction, e.g. to poison ivy, which has happened to coincide with a storm.
  5. [5]This would be one of those times when I’m suggesting something that isn’t considered best practice. The recommended road is usually an inward searching – dig into your feelings and figure out what the cause of the feelings are. This is great advice oftentimes, but is completely useless if the storm is primarily biological. I’m not saying everything is biological, just that there are multiple causes of the storms – and we can’t use one prescription for every illness.
  6. [6]An interesting, older, quirky book on this topic from a Christian perspective is J. Grant Howard’s The Trauma of Transparency.
  7. [7]It is often the case that those who help need to help. Be careful if you feel it is your responsibility to make someone else better, this will cause you to resent the individual you are attempting to help when they don’t recover. It oftentimes results in the helper placing an even greater burden on the “helped.”
  8. [8]This book is awesome no matter where you are at life – one of my all-time favorites!
  9. [9]I know, there are the times when it feels like it will never stop. Since writing this post I have been through times when the emotional pain became so intense that I felt it should kill me. I didn’t understand how it was possible to feel so much. During those times I listened to Art of Dying’s song Get Thru This hundreds of times.
  10. [10]This is no longer the case, one of my doctors found a medication that reduces my insomnia significantly which greatly increases my energy during the day.
  11. [11]See John Bunyan’s Grace Abounding for a powerful portrayal of how some Scriptures can bless and others curse the soul of a mentally ill individual.

Sandy Hook, Gun Laws, and Mental Health

LG Health Exchange Legislation Testimony
LG Health Exchange Legislation Testimony (Photo credit: MDGovpics)

I’ve followed the news about Sandy Hook as much as most average informed citizens – reading articles, listening to NPR/BBC, and so on. I’ve also been following loosely the discussion that has arisen in the aftermath of Sandy Hook about what laws should or should not be made in order to prevent future occurrences of this sort of tragedy.

I wanted to comment briefly on the thoughts which have been circling around mental health issues and whether laws should be implemented to prevent individuals with mental illnesses from purchasing/owning weapons.

This concerns me as someone who suffers from mental illness (OCD, Depression, ADD) and as someone who frequently interacts with and ministers to the mentally ill. Why? Because for years now I have been encouraging folks to seek psychological treatment with the assurance that it won’t destroy their lives and limit their participation in various activities. Even with these assurances I still regularly receive strong kickback from folks who fear that being diagnosed or taking medications will make them an outcast of society, looked upon with suspicion by all. I have seen parents refuse treatment for children and teenagers desperately in need of care, fearing that a mental health record will limit their prospects as they grow older, afraid that the child will be angry when they grow to maturity that their parents took such limiting steps.

Now it seems that folks are considering making laws which would make those suffering with mental illness’ fears a reality. What would be the result of this? First, many innocents would be condemned and limited due to the aberrations of a very few. The vast majority of individuals suffering mental illness are not violent nor a danger to the public. In fact, pick out ten people you interact with on a regular basis and it is likely that at least one or two of them have a mental disorder – and you don’t know it!

What would be the end result of such laws? One of the clearest effects would be fear among the mentally ill to be diagnosed or treated. This would increase rather than decrease any violent potential among the mentally ill – as individuals who most severely needed help (as those suffering from paranoid delusions, etc.) would be the most likely to refuse help.

I find it also disconcerting that the National Rifle Association (NRA) is advocating mental health legislation as the answer – honestly, I’m quite surprised by this. Why? Because mental illness is a murky field and there is plenty more room for the “slippery slope” to take effect regarding mental health legislation than there is for legislation regarding assault weapons to progress to a wider weapons ban.

For example, as far as I have read or heard, the shooter at Sandy Hook had autism (and I haven’t heard of any criminal record?). We aren’t talking about banning some very small and clearly defined subset of mental health disorders – rather, disorders like autism are broad and range from mild to severe impairment. Those with the most severe impairment would not have the capacity to utilize a firearm and those with mild to moderate impairment would not be statistically more likely to utilize weapons in a violent manner than the general populace.

It would not be a large stretch to identify certain forms of religious or political belief as a form of mental illness – and to ban weapons for such individuals on this basis – this could have much wider long-term impact on the right to bear arms than an assault weapons ban.

As such, I am opposed to legislation based on mental health restricting the availability of weapons. I am unsure of what legislation will make a positive difference in situations such as Sandy Hook – the actions of shooters such as at Sandy Hook are so far outside the norm of human behavior that it is difficult to predict what could be done to stop them from acting in such a manner. I do think there are many legislative steps that could be taken to reduce violence generally – for example, prison reform (e.g. as Chuck Colson advocated for, using alternative reformative punishments for non-violent offenders).

In conclusion, I see reasons to legislate as mentioned above – but also believe that our best hope for reducing this form of extreme and horrific violence is through communal endeavors. Specifically, intentionally engaging one another. I don’t think a shooter reaches this place while surrounded by friends. If a shooter does reach such a place, I believe there will be numerous warning signs that friends and family can utilize to report and stop the shooter before any violence occurs. The thought patterns which lead someone to this path are likely formed in intense isolation – thoughts which could be confronted by us if we are willing to reach out.

Evil people, conspiracy theories, dangerous weapons, and mental illness are the band-aid treatment rather than the radical surgery required. The problem with the real treatment is admitting that it involves us changing – and changing in ways that involve us being more outward focused in ways that are self-sacrificing. Not fun – for me or you.

P.S. I’m not saying I am opposed to legislation regarding assault weapons. Honestly, I have no opinion. On the one hand, I see that assault weapons can allow one to kill faster. On the other hand, I think several smaller capacity weapons carried simultaneously would accomplish the same effect and with less difficulty in concealing them. Assault weapons seem more advantageous for individuals involved in violence that isn’t hidden – and this usually isn’t the case with these sorts of shootings – hiding the fact that one is carrying weapons is paramount for these individuals as they infiltrate places of safe haven.

Book Review: Blue Genes (Author: Paul Meier)

Cover of "Blue Genes"
Cover of Blue Genes

Blue Genes is written by Dr. Paul Meier, Dr. Todd Clements, Dr. Jean-Luc Bertrand, and David Mandt Sr. It tackles the topic of mental illness from a Christian perspective and was published as a Focus on the Family Resource book by Tyndale House Publishers in 2005. The book is divided into twelve chapters:

  1. Blue Genes: Hope and Healing for You and Your Family.
  2. Serotonin Blue Genes.
  3. Blue Genes, Sleep and Dreams.
  4. Baby Blue Genes.
  5. Paranoid Blue Genes.
  6. Loneliness Blue Genes.
  7. The ADD Advantage.
  8. Mood Swing Blue Genes.
  9. Hormonal Blue Genes.
  10. Nutrients, Vitamins and Blue Genes.
  11. Blue Genes and the Future of the World.
  12. Dos and Don’ts: Helping Families with Blue Genes.

The book clocks in at a fairly slim 210 pages and is readable while also fairly in-depth on the nature of mental illness and its treatment. It covers a variety of mental illnesses including depression, bipolar disorder, ADD, and psychosis. It tackles the topic primarily from a biological/physiological perspective – that is, it examines the underlying physical issues that cause mental illness rather than the psychological or spiritual (though it does hit on both of these topics as well).
I’d recommend this book highly to anyone who struggles with mental illness, questions the reality of mental illness, works with those who are mentally ill or so on. It is an excellent primer on the subject.
The main thrusts of the books, imho, are:

  • Mental Illness is largely a biological, physiological problem resulting from damaged genes and imbalanced chemicals/hormones. While environment and spirituality also play a role in mental illness – the biological and physiological aspects should be explored first.
  • Mental Illness can be successfully treated by a number of different medications which correct chemical and hormonal imbalances and these medications are safer than natural alternatives and supplements.
  • At the same time, there is a place for the consideration of psychological, environmental, and spiritual aspects to mental illness – and these should be considered and treated appropriately.
  • A proper diet will help decrease mental illness symptoms but cannot be replied upon solely to cure mental health issues.
  • There is great hope to be found in modern scientific developments which are improving the treatments and diagnosis of mental health issues.

I’m a big fan of medications. I’ve been on fluoxetine (prozac) at 60 mg for eight years now and it brings my ability to function from around 40% to 80%. Few folks at this juncture remember me (other than my wonderful wife Charity) during the worst days of my Obsessive Compulsive Disorder – but it was not pretty…so I may be biased in favor of the medical model of mental health treatment – but I do think Dr. Meier and company do a good job balancing the different ways in which we can treat mental health issues and acknowledging the multiple modalities that can be helpful while also trying to emphasize the primary importance of medications in correcting brain chemical imbalances and undermining the myth that struggles like depression are primarily spiritual rather than physiological.

Automatic Pill Dispenser

Update 3/13/13:

Medicine Drug Pills on Plate
Medicine Drug Pills on Plate (Photo credit: epSos.de)

It appears this solution is already well under way by several capable companies. You can read about eight companies in Jonah Comstock’s article over at MobiHealthNews. The last two, by e-Pill and Phillips are not particularly impressive or appealing to me, being based on older technology, but the rest appear quite interesting.

  • Vitality GlowCaps – Being sold out of CVS for $60. First a light, then music, and finally a phone call notify the individual to take their medication. This is a reasonably priced product, though eventually I’d like to see every pill bottle come with this technology built-in and prices drop for separately purchased bottles come down to $5-$10/ea. This apparently requires a base station and also a monthly AT&T service charge.
  • AdhereTech Smart Pill Bottle.
  • Abiogenix’s uBox.
  • MedMinder – This product is impressive and available. It appears that you do not purchase the device outright but “rent” it. The cost is between $40-$60/mo., which IMHO is a bit expensive, I’d like to see maybe $10/mo., but hey, for those who are taking a lot of pills and especially for the elderly with memory problems, this is probably a worthwhile investment.
  • MedSignal’s Pill Case/Gateway – Currently pending FDA approval, only available for research purposes.

If I was the Obama administration, this is one area I’d be looking to foster growth with the expectation that it can significantly reduce healthcare costs. According to Abiogenix’s site non-adherence costs over $300 billion in wasted spending in the United States each year. How about cutting that down by 80-90%?

The Problem

I struggle with overpowering daytime sleepiness. This may be compounded by the fact I take Adderall XR for Attention Deficit Disorder (ADD).[1] I recently went to my psychiatrist and discussed this issue with him[2] and he gave me a supplemental Adderall prescription. This is not an uncommon method of dealing with this increased sleepiness once the medication wears off. I take the supplemental pill later in the day when the first one runs out.[3] In addition to all this, I also take Prozac (fluoxetine) – 60 mg (three 20 mg tablets)[4]. I filled my prescriptions and went home.

The next morning I went into my usual auto-pilot mode – taking medications and vitamins, brushing teeth, showering, deodorant and so on. It wasn’t until I had taken my medications that I realized I had accidentally taken three 20 mg Adderall tablets instead of three 20 mg Prozac tablets. Thankfully, this was not a critical overdose for me…but had it been another medication, it could have been.

But my personal mixup one morning is fairly simple compared to those faced by many others. I’ve worked a bit with the elderly, including those who are suffering from various forms of progressive brain degradation. These individuals find themselves in a dangerous place when they cannot remember during the day whether they have already taken their medications for the day or not. Many of them don’t want to move into assisted living homes just yet, and apart from this sort of minute detail are still capable of living independently…but an inability to remember when medications were last taken can quickly remove this independence.

Lets throw a few more problem areas into consideration. For example, I take vitamin supplements in addition to my medications – Vitamin B complex, Vitamin D, Daily MultiVitamin, Omega-3, and so on. It gets old very quick popping open eight or so different pill containers to get these pills out each and every day (and I know that many take many times more pills each day than I do). Some days I will just my medications and maybe one vitamin supplement and dash off to work…

Then there is the issue of regularity, especially for those with mental illness or who suffer side effects from taking a medication. It is always tempting to skip one day – a few – a week or two, a month. The efficacy of most medications is greatly reduced when taken in this haphazard way and for individuals with mental illness oftentimes results in a significant relapse.

And these are just a few of the challenges facing those who take medication and/or supplements on a regular basis. Sure, they are surmountable by willpower and self-discipline…but when technology can make our lives easier I prefer to spend my willpower and self-discipline on more substantive areas.

Proposed Solution

We’ll talk more about the complexity and cost of this solution later, but I want to note at this point that I believe this could be an extremely affordable solution. In early stages I wouldn’t want to see its cost exceed that of the Raspberry Pi computer at $35…and with wide utilization I would see this being a commodity product that would replace traditional pill containers at no-cost to the consumer.

If you know me, you know I’m not an artist, but here is my attempt to depict visually what the solution would look like…I’ll step through it as we go on…

Figure 1. Automatic Pill Dispenser

The automatic pill dispenser is expandable. The above figure represents a dispenser with six individual dispenser units. If one had only one medication, one would need only one dispenser. Each additional dispenser can simply be connected (think legos) to the next. Dispensers could vary in size – but the goal is that they be as small as possible, allowing for a good number of them to be connected together without consuming significant space.

  • Each dispenser would have a small display which would show the number of pills remaining in that dispenser.
  • Below that another small display showing the quantity an individual programmed the dispenser to give each day.
  • The Give button would dispense the above desired number of pills – if they had not already been dispensed for the day.
  • Holding down the Give button for ten seconds would force it to release an additional pill (e.g. if for some reason the system malfunctioned and dropped only one pill when it should drop two, this would allow one to “force” the system to drop another).
  • The + and – keys would be used to change both the number of pills in the unit and the quantity to be given each day. You’d hold down the plus key until one of the displays above began blinking. Whichever display was blinking indicates the display you would be changing for the value of.

Ideally, eventually pill boxes would no longer be distributed – each pill box would be one of these dispensers. It would come pre-programmed with the correct number of pills and dosage. Until such a time it doesn’t make sense to have the pill dispensers be disposed after each use – so they would be refillable. One would dump the new medications when received into the dispenser and reset the dosage and number of pills.

A Little More to It…

This in and of itself would be extremely helpful…but I’d like to take it a little further. Did anyone wonder why the units lock together? Besides making it orderly there is another reason. Each unit would have its own “intelligence” (that powers the display, etc.), but one would also have a lock-on extra unit that would contain a central brain. Really this brain would be very weak (and inexpensive). It would consist of a WiFi chip that would relay information from the pill dispensers to a central hosted server transparently.

Individuals could open up their web browser, type in the website (say davesamazingpilldispenser.com) and login using a username and password they select. Once inside they would be able to (a) set values from a web console rather than on each dispenser (this would be much quicker for those who have lots of pills), (b) determine accountability partners who would receive email alerts when the dispensers were not decrementing at the expected rate (e.g. someone stops taking their pills for x number of days perhaps the doctor, spouse, or family friend is notified via email or text message), (c) view (and share if desired) charts indicating their history of medication use (this would help, for example, when a medication needs to be taken 3x a day…the dispenser would mark each time the pill was taken and this could be analyzed by the individual or a doctor for issues).

Now, all of this can be done fairly simply and initially. Further on one might add the ability for the pill dispenser to automatically order refills of medications/vitamins via integration with online pharmacies / amazon for vitamins.

Talking About Price

The dispenser boxes are using fairly simple circuits and mechanisms. I don’t see any reason why these could not be manufactured very cheaply. I’ll work on putting together some figures – but my goal would be that each dispenser would not cost more than $5 and the WiFi component $5-$10. Thus, if one takes six medications and wants WiFi one might make an investment of $35-$40. Factor this out over a year and it is an expense I think worthwhile…and there is no reason the dispensers could not last for multiple years – especially if the web console is used instead of the buttons (which, over time, may wear out).

What It Won’t Do

There are a few things the initial pill dispenser wouldn’t do – though I think these features could be added over time. The biggest of these is that it won’t keep people from abusing it. That is – someone will be able to break open the pill dispenser, tell it to give more than they should be taking, or have the dispenser release pills and then throw them away. I believe the vast majority of issues with medication adherence are related more to accidents and forgetfulness than to deceit or other maliciousness. Creating safety mechanisms in the initial device would raise the cost significantly – and unnecessarily – for the vast majority of users.

Doesn’t Somebody Already Do This?

There are a few companies I found who build automatic pill dispensers. These include MedReady and ePill. However, I was disappointed in these units as they all lacked various features…and most significantly, they are quite expensive (anywhere from $100-$900). I think this industry is ready for disruption.

What Now?

I’m not sure. This is an idea I think is simple enough to be accomplished. I guess I’ll put out a call to see if anyone is interested. Maybe you are? I’d love to hear thoughts and contributions from the MAKE and Kickstarter communities and from those who would be interested in using/purchasing such a product. I see the components necessary to undertake this project and build a prototype as follows:

  • Manufacturing: We’d need to manufacturer the automatic pill dispenser. This would mainly be a simple pill box but with the addition of a mechanism to release pills.
  • Circuitry: We’d need to develop the circuitry to operate the machinery, interlock with other dispensers, and allow changes to the values stored by the dispenser.
  • WiFi: We’d need to create the wifi unit.
  • Web Console: Data would need to be parsed and displayed via a secure web portal.

If you work or are a hobbyist in any of these arenas, I’d be interested in hearing from you. The web console I could fairly easily take care of myself…but I do not have significant experience with building circuitry or manufacturing. I do have a good bit of programming experience, but not much in the area of device automation…

Money?

We can discuss how any revenues – should they arise – would be distributed…but at this juncture I am largely interested in creating a prototype. I’m willing to donate time and effort to the cause and are looking for others interested in doing so…but there isn’t any money here to start with, so no need to contact if you want to be paid up-front for your work…maybe someday there is a hope you might be…but, its just that a hope – for you and me.

If it comes down to it I’d rather see it implemented with no profit margin than derive profits with only limited distribution.

Thanks

Diagram.ly deserves a big thanks for their sweet and free online diagramming software I used to create my artistically challenged 2D diagram above.

  1. [1]My daytime sleepiness predates taking medication for ADD, so there isn’t a causative link. The Adderall does help me stay awake and focused, but when it  flushes out of my system it may cause an additional “crash” in addition to the regular sleepiness struggle.
  2. [2]Yes, I see a psychiatrist on a regular basis and have for a number of years. I feel a bit embarrassed about it – which is funny, as I talk about my mental health issues all the time…I guess saying one sees a psychiatrist makes the problems more “real” and “severe.” But I committed to reducing the stigma surrounding mental health issues, so I’ll leave this in the article.
  3. [3]For those who would suggest that I may have a sleep disorder – e.g. sleep apnea or etc., I agree…though oftentimes the treatment for these disorders is similar to ADD. I have undergone a sleep study at Abington Hospital and am looking forward to an upcoming discussion regarding the results of that study with my primary physician.
  4. [4]Yes, that does seem high…it is. Depression generally responds to significantly lower doses, but Obsessive Compulsive Disorder (OCD) does not and requires higher doses before it provides substantive relief.

Why I Talk About My Mental Health Publicly.

Darkness Explained…

Tropical Depression One-C
A tropical depression, somewhat similar in feeling to our internal emotions at times. Image via Wikipedia

I speak and post on a somewhat regular basis about my mental health in public forums. On Dec. 15th I wrote a status update on Facebook, “see it now with its foul stench, oozing black skin, rapacious talons. depression, a dark and vicious wraith, pulls down upon my soul…”

I don’t make these sort of dark and pained posts a daily habit, but you will see them occasionally as my status updates, read blurbs about them in my emails, and even hear me speak of them from the pulpit on a Sunday morning.

I’d like to take a few moments to explain why I have chosen to share these struggles so publicly…

It Isn’t Easy…

It isn’t because it is easier to share my struggles. In fact, the older I grow and the more responsibilities I assume – at work, at church, in the community – the less I want to be open about my struggles with others. I know there are people who judge me weak for my struggles – and that when I share them they question my ability to work or to lead. It would be easier to just clam up and pretend I wasn’t struggling – to keep my struggles silent.

For the Weak…

Yet I recognize that there are many who are weak and struggling who need permission to acknowledge their own weakness.[1] There are many with deep inner turmoils who feel hopeless, lost, isolated, and judged…and unless someone stands up and says, “I will not be ruled by anyone’s  judgments of my spirituality and ability” they will remain quiet.[2]

For the Judgmental…

At the same time, I also know that many of those who bring the harshest judgments and incur the most guilt and disdain upon the weak and suffering are those who are most weak and suffering themselves. Oftentimes they are not even cognizant of their own weakness. Everyone else can see the flaws in their character, the weaknesses in their constitution – but they themselves are blinded, unwilling to see weakness within, choosing to highlight that which is without.[3]

So, it is necessary to stand against them. Not against them, but against this idea – this floating conception which we all partake in, this ballroom masquerade[4] We must stop pretending we are superhuman and instead acknowledge and wrestle with our humanity.

In the Moment…

At times I have thought about moving to a past tense form of sharing. It is true I have struggled with x, y, and z in the past and I can share with you my victory over them…but this is only a half-truth. Surely, I have learned much about conquering and resisting and coping with my weaknesses over the years and I have had many victories and many defeats.

Yet, the truth is, I still struggle. Some days are good and some days are bad. Sure, I can act as if everything is okay and you won’t know. Us OCD folks are renowned for that – our ability to perform rituals for hours each day, to suffer extreme internal mental anguish, and yet to go on functioning as if life is normal – with no one knowing any better.

I was not weak in the past – I am weak now. So, I continue to share that I am weak now…and I assume when you hear me preach you know that I speak the truth as best as I am able while recognizing that every truth I am also wrestling to make true in my own life.

[Note: I have written a second page as well which contains a few caveats and delves into some important miscellany. Look below the footnotes below for the link to page 2.]

  1. [1]I call these weak b/c I am weak. I would suggest we are all weak…and if we don’t recognize it, perhaps we have some self-reflection to do. :)
  2. [2]At the same time, I do not want to portray myself as some hero. I know the difference it made in my life that others spoke openly about their struggles – and so I imitate them. On the other hand, I know also that revelation of my own struggles sometimes secure me understanding and wiggle room that would not be given if I simply kept these struggles internalized. Admitting our weakness provides a certain freedom to fail which can become pathological. I struggle to maintain a balance, to share my weakness for the right reasons, and to recognize when I have walked down the wrong path.
  3. [3]And if you agree with me on this statement, then you must examine your own heart – as I am examining mine – for the truth is as we say these truth we may fall into the same hypocrisy and judgment that we disdain in others.
  4. [4]Thank you Thousand Foot Krutch.

Fiction Book Review: The Bride Collector (Author: Ted Dekker).

The Bride Collector by Ted Dekker tells the story of an FBI agent (Brad Raines) who is in rabid pursuit of a serial killer known only as The Bride Collector. In the process Brad forms an unlikely alliance with several patients of a residential mental health facility – who in their own awkward ways assist him in discovering the identity of and stopping The Bride Collector before he can kill more victims.

There are some Ted Dekker books I feel are masterful stories (Adam, Thr3e). There are some which I read but didn’t care for (Skin, House, Showdown, Saint, Sinner). There are those that seem like just another rehashing of already told tales (Boneman’s Daughters). Now it appears I must add a fourth category: the stories that are not masterful in-and-of themselves, that feel partially like a rehashing – but yet distinguish themselves for their message.

Over time Dekker’s books seem to move more mainstream and to remain less and less in the Christian thriller niche. The Bride Collector certainly feels this way, and yet it is with great conviction that Dekker portrays a message of high importance to his readers. What message? That those who are mentally ill are not so different from the rest of us. That the monsters of this world are as likely to be sane and rational as insane and that there is still bountiful humanity and intelligence in those who are maimed in some way in the mind.

I’d encourage anyone who wants a thought provoking and entertaining read about the nature of mental illness, the humanity of its suffers, and the insanity of every man to consider The Bride Collector.

P.S. I read this book on my Amazon Kindle!

Free Educational Courses (Online)

High Dopamine Transporter Levels
Image via Wikipedia

NetCE is an online continuing education provider for various professionals who are required to earn a specific number of continuing education credits per year to remain accredited with the state. They offer courses for medical professionals (e.g. nurses, physicians, dentists), counselors, psychologists, and social workers.

Each course by NetCE is available online for free. NetCE makes their money by providing credit for the courses. If an individual takes a course and proceeds through the testing they then pay a fee for the course (still nominal – e.g. $20-$50 usually) and receive credit for the course. NetCE seems like a great way to complete required CEU’s, but it is also a high quality source of information for anyone.

I’m particularly interested in counseling/psychology and I found a number of excellent courses on their site and have been reading through them. They are professional and extensively documented. No need to register or pay to read them! Here are a few of the courses I thought looked interesting:

Omega-3 Supplements (Coromega)

horsepills
Image by D’Arcy Norman via Flickr

Omega-3 is believed to be helpful to the body for all sorts of reasons. The Wikipedia article on Omega-3 fatty acids notes research indicating that Omega-3 can be helpful in battling cancer, reducing cardiovascular disease, improve immune system functioning, improved mental health, and the reduction of inflammation.

Unfortunately, our diets contain significant less Omega-3 in them than they have historically – this is due to a significant decrease in our consumption of fish. We could increase our consumption of fish – but then there are concerns about mercury toxicity and for people such as myself – we simply don’t like fish!

There have long been supplements available – usually in capsule form – of Omega-3. These pills have traditionally been quite large (and difficult to swallow) and I’ve found that after consuming them I have a very bad aftertaste and occasionally burp fish breath. Yuck!

Several years ago I discovered Coromega – and I’m a huge fan! While more expensive than traditional Omega-3 supplements, Coromega greatly deserves the extra cost because it:

  • Comes in small yogurt like packets and tastes sweet – very easy to consume and very easy on the taste buds.
  • Doesn’t give you a bad aftertaste and doesn’t cause fish breath burps.
  • Has 300% better absorption than many of the softgel capsule alternatives.

You can learn more about Coromega at the official website. I purchase my Coromega from Amazon, a three month supply is around (or $20.50 if you have Prime!). That is $8/mo! Not too bad.

Why do I take Omega-3?

  • I have Obsessive Compulsive Disorder (OCD), Depression, and ADD and Omega-3 is believed to assist in proper mental functioning.
  • I am a knowledge worker (IT) and need my brain to function at its peak for prolonged periods of time – something it can’t do without Omega-3.

My First Two Weeks (+/-) with the Zeo.

Thinking of the Poor:

Observing the shabbath closing havdalah ritual
Image via Wikipedia

I’m not a fancy person in most areas. I try to save my money and spend it on things I think are worthwhile and valuable. For example, sponsoring a Compassion child. So, what am I doing spending $200 on a glorified alarm clock – the Zeo? I’m glad you asked. Individuals whose hearts for the poor and neglected like John Sherk and Rob Timlin may be especially interested…and, I’ll let them decide whether my thinking is valid or if I need to be lovingly taken to the woodshed. 🙂

What About My Sleep?

Let me provide a three word summary of my history with sleep: it wasn’t nice. But, most of my history of sleep is non-relevant to today’s discussion, so let’s focus in on a few relevant points:

  1. I can’t go to sleep before midnight or I wake up 2-4 hours later and then can’t sleep for the rest of the night (which is a real drag when you have to work the next day).
  2. I get inexplicably and overwhelmingly exhausted throughout the day – and without structure – will fall asleep…and usually remain asleep for 1-3 hours.
  3. No matter how hard I try, I repeatedly fail at getting up early in the morning so that I can have the time I want to have to get ready for my day…I end up pushing the snooze button and sleeping in, then  hopping out the door in  mad rush.

Now, sleep is apparently important to our health. We don’t understand all the underlying magic – just that bad things like insanity and death happen if we don’t get it. It does all sorts of great things for restoring our health, cementing our memories, and so on. Perhaps God created sleep b/c He knew we’d be so bad at take Sabbath’s otherwise?

I Want a Zeo!

So…I’ve wanted a Zeo forever (okay, okay, maybe its been like two years?) and have held off and held off…but Charity (wonderful wife that she is) in an attempt to get me to actually bill my freelance network clients (I don’t mind the work…hate the billing) suggested that I use part of the revenues from my next few checks to purchase a Zeo (incentives…they work with kids, and apparently me…)…well, guess who only waited another month before billing? Yup, that’d be me!

The Zeo Arrives

I bought my Zeo and waited painstakingly for its arrival. Finally, it arrived. I opened the shipping box and inside, low and behold, was another box! But this was one fancy – you know, like Apple aesthetically pleasing fancy. Everything inside was all nicely wrapped and fancy. Its amazing how the packaging makes the product feel premier.

Using the Zeo: For Information

The first aspect of the zeo is its’ information aggregation and analysis. You wear a comfortable headband on your head while sleeping (yes, as awkward as that sounds…I had no trouble adjusting) and this wirelessly communicates information to your bedside zeo about your sleep patterns. In the morning you can see your overall ZQ (a “score” of how you slept), how often you awake, when you were in deep sleep / rem sleep / light sleep, and view all sorts of fancy charts and graphs. Zeo also offers guided coaching that helps you modify your habits to get better sleep.

I found this information very helpful b/c it provided me with an objective gauge of whether I got enough sleep the last night. I could see patterns forming where I wasn’t getting enough sleep for a few days, and then when I made the endeavor to get enough. I could also see and record the difference in my feelings / energy / etc…though I’ve barely taken advantage of most of these capabilities at this juncture.

Using the Zeo: Smart Awake

Honestly, the feature that has been killer for me thus far is the Smart Alarm. I tell the Zeo when I want to wake up and it wakes me up to 30 minutes before that time. Crazily enough, I usually feel better – even if I get 30 mins. less sleep, than if I’d slept right to the end. See, the Zeo tracks what stage of sleep I’m in and wakes me when I’m in light sleep rather than deep sleep – reducing my feelings of grogginess.

This has made a huge difference in my sleep habits. I’m now much better at getting out of bed on time. I’d estimate that I’m “gaining” 30 minutes to 1.5 hours each day due to the Smart Alarm feature. Granted, some of this may be placebo effects – time will tell.

Doing the Math

Now the question is – can we justify such an expense in light of the needs of the world? This is always a hard-pressing question upon my heart. For the past year or two I’ve taken a more dynamic approach to this question than I had previously (where the answer was almost always to sacrifice everything, whenever possible). I’ve begun to do little auto-magical (e.g. made up) calculations within my head to try and estimate the value of my time and how much money I am “saving” by “spending.”

For example, the Zeo cost me $200. Let us say my time is worth $10/hr.[1] Lets take the conservative figure of time gained each day (30 minutes) and multiple that times a year (30 mins. x 365 days / 60 mins.) – 182.5 hours. Now, lets multiple this time gained by the amount my time is worth per hour (182.5 hrs. * $10/hr.) – $1,825.

Over a years time, I’m “gaining” $1,625 for an expense of $200. Granted, my time gained does not automatically translate into productivity…but to break even I’d only have to spend 20 of those 182.5 hours being “productive.”

The equations make sense to me, but do they to you? I use similar equations when deciding if I should purchase a video game, continue or cancel a subscription to Netflix or Grooveshark, and so on. My goal is optimal stewardship at minimal expenditure…but I think I’m trying to move beyond thinking of stewardship primarily in dollars to whole being…

Thus, while x might cost x amount, if it enables me to function x% better on an average day, I need to consider whether “indulging” will in the end “return” a value greater than the expenditure? e.g. How do we quantify the value of a honeymoon or romantic getaway for a husband and wife? Can we, should we, factor in the cost of a divorce down the road if the marriage is not indulgently cared for along the way?

This said, I think as Americans (including myself) we are grossly overspending. If we do adopt such a paradigm for measuring return vs. expenditure we must actually take the time to calculate the return, rather than using it as an excuse for gluttonous fulfillment of our pleasures.

Some Interesting Stats…I Don’t Know What They Mean…

I received a baseline report from Zeo on my sleep habits…I thought the findings where fascinating, though I’m not sure what they mean…here are the highlights:

  • I currently sleep an average of 6:01 hrs. each night, this is 1:19 hrs. less than the average for my peer age group.
  • Despite the significantly lower time spent asleep I show a significant front-runner status in both my REM and deep sleep.
    • In REM, I spend 1:49 hrs. while my peers spend 13 mins. less.
    • In deep sleep, I spend 1:50 hrs. while my peers spend 27 mins. less.
  • How is this possible that I get less sleep but more of the “quality” sleep? Its because most of my peers spend nearly twice the amount of time in light sleep (4:22 hrs.) as compared to me (2:23 hrs.).

In Case You Are Interested…

This is mainly if some sleep doctor happens to stumble across this post and is interested, here are a few other idiosyncrasies of my sleep habits:

  • I get very tired while driving or while in a car at all. Despite my hardest endeavors, if not driving, I almost always fall asleep on drives – oftentimes even relatively short ones (e.g. 30 mins.).
  • Exercise does not seem to significantly reduce my tiredness or help me push through it.
  • I get sleepy when I have been thinking a lot, this means I have a tendency to nap more on the weekends – b/c I tend to do a lot of reading/thinking.
  • While napping during the days I oftentimes prefer to sleep with as many lights on as possible…but when sleeping at night I am bothered by even the smallest of lights.
  1. [1]I’d certainly hope its worth more…but I’m just being conservative.