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!

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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 $24 (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.

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• Omega-3 Fatty Acids (dogfyi.wordpress.com)
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• Omega-3 Fatty Acids May Help Depression (fyiliving.com)
• Scientific research reveals brain alterations linking omega 3 deficit with depression (physorg.com)
• Are Supplements as Good as Fish? (everydayhealth.com)
• Guide to Omega 3 Fish Oil Supplements (brighthub.com)
• You Asked: For Omega-3s – Flaxseed Oil or Fish Oil? (fitsugar.com)
• Can Fish Oil Relieve Pain? (everydayhealth.com)
• A List of Cold Water Fish High in Omega 3 Fatty Acids (brighthub.com)
• Who Needs Omega-3s? (webmd.com)
• Boomers need to boost their Omega 3′s – article by Scott Keith (itsaguythingblog.wordpress.com)
• Upping Intake of Omega-3s (everydayhealth.com)
• Taking Fish Oil Supplements – A Primer (fyiliving.com)
• Fish oil won’t help you lose weight, experts say (independent.co.uk)
• Treat depression with omega-3 fatty acids (mamavega.wordpress.com)

I share frequently and publicly – in “real life” and via the internet – that I have and continue to struggle with both Obsessive Compulsive Disorder and Depression. I do this for a number of reasons:

1. To help those who are currently too embarrassed to admit they are struggling with a mental illness get the treatment they need.
2. To reduce the stigma associated with having a mental illness.
3. To raise awareness of the many forms in which mental illness exists and to encourage individuals to be understanding of those who suffer from various forms of it.

I must admit, it is a bit harder for me to say that I probably have trichotillomania as well. First off, the name just isn’t conducive. Its too long of a word, too unfamiliar, and it ends with “mania” which many equate with “insanity.” But, if I’m going to be honest and open – I need to admit that this is something I struggle with as well.

Trichotillomania is the compulsive pulling of one’s own hair. In my instance is a fairly mild instance and does not cause significant life disruption. During my teenage years while working as a field stone mason I pulled out a lot of my hair on top of my head (I ponder if this corresponds to my young balding), but these days it largely revolves around pulling on my eyelashes – which irritates my eyes.

I am very aware of pulling on my eyelashes and battle quite vigorously to not do so, but eventually give in. It is an extremely frustrating feeling. Recently, with aging and as I rack up the years working full-time in front of a computer (in IT) my eyes have become more bothersome. After checking with a eye doctor it seems evident that this is not caused by a deterioration of my vision but rather from the constant picking and rubbing I pour out upon my eyes.

In my endeavors to find new ways to battle this compulsion I came across the Trichotillomania Learning Center, and while I’ve only begun to explore this extensive resources I am quite impressed. Trichotillomania is not a well-known disorder, there is no Monk for trichotillomaniacs as there is for OCD, nor has depression been repeatedly portrayed in major movies, television shows, and books over the years – yet this organization has managed to create an impressive resource for anyone suffering from trichotillomania – a resource that outstrips many of those available for more well-known and statistically prevalent disorders. For this I must grant them uber-kudos.

I do feel a little overwhelmed by this beautiful site, so if like me you just want to get the big idea…I’d click on “For Adults” on the left-hand navigation. Then choose “What is Hair Pulling?” and from the drop-down menu that appears choose “Causes.” In this section you will find a link to a PDF article aimed at medical professionals treating individuals with trichotillomania, but it is a very straightforward and easy read – so I’d recommend it as a great starting place for just about anyone – especially if you have some basic understanding of the various mental disorders (e.g. ocd, depression, anxiety related), treatment modalities (cognitive, behavioral), and medications (e.g. SSRIs like fluoxetine).

Related articles

• What are the Most Effective Behavioral Treatments for Trichotillomania? (brighthub.com)
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• Struggling With Trichotillomania (wasdstomp.com)
• Study: Help for Chronic Hair Pullers? (time.com)
• Curing obsessive-compulsive mice with bone marrow transplants [Mad Science] (io9.com)
• Understanding OCD – What Causes Obsessive Compulsive Disorder (brighthub.com)
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Tonight I am sadly disappointed. I finally had a chance to read the Feb. 8 2010 issue with a promising cover story on antidepressants by Sharon Begley. I had expected, in common Newsweek fashion, to find an extended report on the overall story supplemented by articles from various perspectives – I was sadly mistaken. Begley’s article used recent controversial findings to smack around the efficiency of anti-depressants rather ferociously, then there was a small, one-page response from Robert Klitzman, a psychiatrist, author, and professor at Columbia University.

Jon Meacham, what happened here? Begley’s article highlights some interesting and thought-provoking research findings, but doesn’t seem to seriously consider the issues with the research findings. Klitzman’s article, while raising some important issues, is too short to offer a resource defense against Begley’s article. Klitzman’s use of personal, subjective experience is entirely worthwhile, but in an article this short it seems to overshadow the more scientific issues relating to researchers’ methodology in acquiring these results.

I haven’t had time to read the original research publications and probably won’t…nor am I a qualified mental health professional…but as an individual who has suffered from Obsessive Compulsive Disorder (OCD) and Major Depressive Episodes for all of my conscious life, I’d like to share a few observations:

• One must correlate not only the effectiveness of a single drug but the effectiveness of a class of drugs on the individual. For example, this study reflects that an individual in a clinical trial for say Prozac experiences only a 1% decrease in symptoms – similar or identical to a placebo effect. What the study does not correlate is how that same individual responds to different drugs used to treat the same disorder. For example – if this individual uses Zoloft, Paxil, etc. do they experience a more significant reduction in symptoms? One of the differences (for me) between Zoloft and Prozac is weight gain versus weight loss/stability. Future studies need to consider the effectiveness of a class of drugs in treatment of an individual versus an individual drug. Thus the question is, would any drug within this treatment class significantly reduce the symptoms of the sufferer? If so, this is a victory for “anti-depressants” in general. One cannot suggest that anti-depressants as a class are ineffective without considering their effectiveness as a class on the individual. Ineffectiveness in a case study of treatment of an individual with a single drug is not evidence that anti-depressants don’t work but that that specific anti-depressant doesn’t assist that individual.
• The lumping in of the varied forms of depression is a significant issue as well. There are significant differences between the forms and intensity of depression which is further complicated by coexisting disorders. Yes, situational depression (e.g. death of a friend or family member) is likely to resolve itself – but this is very different from the depression which simply sits upon a person like a funk – with no rhyme or reason. Dysthymic Depression has different implications than a sudden Major Depressive Episode.
• I’m not aware of anyone advocating that we pop anti-depressants like tic tacs and yet the article seems to indicate that these anti-depressants are being handed out to anyone who is experiencing a bit of grief. There is little disagreement, as far as I am aware, that medications are not a panacea for depression and that they should be utilized in moderation, in combination with other approaches, and for depression which appears to be ongoing and severely limiting rather than limited and minimal.
• Begley recommends psychotherapy as an effective alternative treatment, but that is a very general class – much more general than the anti-depressants mentioned. What sort of psychotherapy is being referred to? Psychoanalysis? Cognitive-Behavioral?

I would have liked to see someone like Peter Kramer who wrote the excellent book Against Depression write a response to Begley’s article (I think Klitzman is also fully capable of writing an article of such a nature given a more extended page count…I mention Kramer because he has written extensively on this subject). In the end, I simply want to suggest that Newsweek should be more careful in how they handle topics like this. It felt extremely one-sided and was not provided the depth or breadth I’ve come to expect from Newsweek.

The article raises good questions. We need to be considering the efficiency of our antidepressants. We need to be pushing for alternative treatments that don’t require the introduction of potentially harmful chemicals into our bodies. We need to smash any mentality that considers every blue mood an instance of depression and worthy of a few pills.

But where, oh where, where the articles talking about what sorts of psychotherapy are effective for treating depression? Where was the article even defining depression? Where were the articles talking about the efficiency of these same anti-depressants for other disorders – for example Obsessive-Compulsive Disorder? Where were the articles on how to improve our system?

Update 2/06/10: I’d like to thank Peter Kramer for taking the time to comment on this article and would like to point everyone’s attention to the several articles he has written in response to Newsweek’s article and the underlying research used in the article

• Here is an article for Slate that Kramer wrote explaining Irving Kirsch’s understanding of tianeptine and why it isn’t the clear-cut evidence Kirsch suggests. Kramer has some fairly strong words for Newsweek, “To set aside the testimony of animal model research, brain enzyme research, the new work on neurogenesis, and on and on—this stance has the whiff about it of science denial. It is one that a major magazine should have showcased cautiously, if at all, and only after having done some serious homework.”
• Here is another article for Slate in which Kramer evaluates the results of the recent JAMA study and demonstrates significant concerns acknowledged by the U. Penn researchers themselves concerning the efficacy of drawing conclusions on minor depression from this study.
• Finally, Kramer responds to arguments that individual responses to placebos are significant by noting that the test groups in studies reflecting this result oftentimes include a number of test subjects who don’t have the disorder – thus the apparent efficiency of placebos.

On Medication & Side Effects:

I do not want to discount the real concern that there are potential side effects from consuming medications that interact with our minds. Unlike many of our other organs which we understand to a great degree, the brain still resides as a major mystery and our treatments for aberrations in this mysterious and fascinating organ are far more primitive than any of us would desire. On the other hand, I’d like to share a few observations in my personal battle in deciding to consume medications:

• The damage from mental aberrations is certain, the damage from medications is small (or unknown). Peter D. Kramer in his book Against Depression
  writes, “In the aged brain, strokes cause more injury than they do in the young brain, and so do infections, blood clots, inflammation, low blood sugar, seizures–you name it. Prior exposure to stress (and to stress hormones) is the critical factor in this age-related vulnerability. More stress in the past makes an animal more brittle in old age. Both neurons and their protectors, glial cells, are at risk.” “Much of the damage done by stress hormones is to the stress-response system itself. The brain is a complex communications network, one cell reaching out to another. In the face of stress hormones, neurons lose connective wiring. In particular, cells in the hippocampus shed receptors for incoming messages about stress. The hippocampal cells also lose dendrites, the branches that connect a neuron to neighboring cells and transmit outgoing messages. Like overwhelmed people who withdraw from social contact, overwhelmed neurons in the hippocampus become isolated.” (pg. 117) Point being, while there may be unknown long-term side-effects to taking a medication there is no doubt about the health effects of untreated aberrations on the human mind.
• We have a certain fear of losing ourselves through medication. We ask ourselves, “are we just druggies, in need of a fix to make ourselves feel good?” We ponder whether there is not some good side to our illness.[1. I don't want to tackle this question in too much depth, but let me briefly summarize my position. There are lessons that can be learned while undergoing a challenge of any form - physiological, mental, familiar, economic - but these lessons are pain that is utilized by God for good, they are not in themselves good. In the Scriptures we do not find Jesus (the incarnation of God) saying to those who asked for healing, "I'm sorry. Its better for you be ill. I won't heal you." No, we find him bringing hope and healing. There is more than enough pain in this world, more than enough challenges, lets not purposely embrace unnecessary challenges - lets heal where we can and depend on the grace of God throughout.] We fear that society would lose a certain portion of itself without those who mentally struggle. We ask what would have history been like if individuals like Martin Luther, Picasso, van Gogh, Kierkegaard, George Fox, and so many others of our great minds had not suffered?[2. Peter Kramer tackles this topic extensively in Against Depression
  , a book that while to all appearances on the disorder of depression has more to do with fighting the cultural value we have given depression (and can be extended logically to other disorders).] This is the question, but we are simply asking it the same way. One does not lose depth without disorder. When one removes the disorder one finds greater ability to tap and manage depth. The disorder disables the individuals, removing capacity to innovate, it does not add to it.
• Yet, there is still a concern about the medication. There is no doubt that medication can affect us in ways we do not expect – in fact covering over portions of what we consider our personality. Sometimes the side effects are the exact opposite (though only in a very small minority) of what is expected – instead of relieving depression or anxiety it increases it. This is why I suggest the involvement of a community in the process is essential. At the most basic one’s psychiatrist, but preferrably including friends and family. These individuals can objectively help you understand the effects of the medication on your daily behavior and assist in determining whether the medication is allowing the real you to shine out or masking it (the latter is marginal, but possible).
• We assume that medical illness is a choice we face in isolation, but it is not. While we assume that refusing treatment is solely our suffering we cannot underestimate the impact of our suffering on others. The lack of energy we feel translates into a lack of energy for friends and family. The sudden bouts of rage we battle flies out at the most uncomfortable times – at work, with our wives or children. Our illness is real and affects those around us. If our worldview is twisted, we impart this twisted worldview to those we interact with to some extent. We must recognize the extent of others suffering.
• We oftentimes assume that our suffering isn’t that bad. We are resilient people in many senses. Many of us operate on a decently functional level without medication. Especially as adults we learns methods of coping with our foibles. But there is a great difference between functionally nominally well and functioning to one’s true human potential.[3. When I speak to "true human potential" I do not mean the actual perfection of mankind. I do not want to embark on a theology lesson, but it is my firm belief that we are beyond hope in (via natural means) redeeming our broken selves (and thus in need of a more than natural (supernatural) escape). When I speak of "true human potential" I mean a level of functioning which we as broken humans can embrace. It is not the full escape, but it is better than. The individual with clotted heart may need stints, this will make life better - allowing him to act to his "full potential" as opposed to without stints. At the same time the individual still is not "whole" in the sense of having a perfect heart.] Some of us have been suffering for so long that we don’t know what it is like to be free. Even after a short while in the grip of a mental illness it feels natural, as if this is the way things should be. Yet I have experienced (and proudly bear witness to) becoming more myself (and it is the self I strove for but could not be) when accepting and receiving treatment.

What About Them Psychologists/Counselors?

There is a fear of psychologists/counselors that permeates many and especially amongst those who would consider themselves Evangelical Christians (of which I consider myself a constituent). The fears are not entirely unfounded. There have been individuals who have seen a counselor/psychologist who provided bad advice and have changed their lives for the worse because of this advice[4. Probably one of the most ready examples to Christians is recommendations to divorce a spouse.]. But I would suggest that we need not fear the psychologist (or counselor) but instead the uncritical thinking and lack of contextual support that allows illegitimate beliefs to grow. In my opinion, a counselor is an individual to dialogue with about our lives and whom we allow to speak honestly and openly with us about the issues they see in our lives.[5. With Larry Crabb (Soul Talk: The Language God Longs for Us to Speak), it would be my hope that eventually this sort of "soul care" could be performed by one another. Unfortunately, at this juncture, too often this help is not available and those around us (including ourselves) are not able/willing to enter into the required depth of dialogue.] When we give someone permission to explore our life and philosophy this does not mean we give them permission to determine our beliefs. We can and should critically evaluate each suggestion for its truthfulness. Additionally, I would suggest that counseling becomes much safer when one uses it as a primary means of exposing the difficulties in ones life but then also utilizes a secondary support system to give you context to the recommendations and issues raised. While many people are not prepared to provide the depth of inquiry and feedback that a counselor can, many of them are willing to discuss with you individual subjects which the psychologist raises. Thus the danger of psychology is not that there may be false beliefs but that we uncritically and without contextual relational support accept such beliefs. No individual has perfect knowledge, every encounter is a mixture of truth and error, this is true even for professionals. We must be willing to battle for truth on our turf, not simply accept the pronouncements of others. That said, having someone challenge our belief system can help us revise and strengthen our belief systems in ways that allow us to live better lives.[6. When I speak of better lives I mean in many ways - less painful, less stressful, etc. But to me the ultimate depiction of a better life is the ability to love and know God and one another despite circumstances. Everything else is frosting on the cake.]

Are We Willing to See Ourselves?

When it really comes down to it, my argument is not so much particularly for psychological medications and treatment – but for the willingness to explore ourselves, and not solely internally. You can sit down and talk with a psychiatrist and a psychologist without taking medication and without accepting their advice. But perhaps it is worthwhile to ask the question? To open ourselves to the possibility? To ask someone else, “Do you hurt this way every day? Do you feel this anxious? Do you have this much trouble sleeping?” So often we assume our suffering is normative, when it is anything but.

Please feel free to give me some feedback on this post. I know this post has been much more ideological than many others I have posted but I want to engage you in discussion about this. I am at much risk of mixing truth with error as any other fallible human being. Perhaps that is one of the reasons why God said after creating everything else “good” that “it is not good for man to be alone.”[7. In an ultimate theological sense, even the community of mankind is not enough. We can do better by working together, but we still find ourselves to fall short. Extra-natural inspiration and revelation is needed (I could just say "supernatural" but this word is beaten to death like a horse and connotes all sorts of wishy-washy sentamentalism that so many reject without considering the underlying import of the word. By changing words I am not changing the meaning but simply attempting to force us to process those things with which we have become so comfortable (or uncomfortable).)]

Obsessive-Compulsive Disorder (OCD):

According to the National Institute of Mental Health this disorder affects 2.2 million U.S. adults each year. The NIMH defines OCD as, “…an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as handwashing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called ‘rituals,’ however, provides only temporary relief, and not performing them markedly increases anxiety.”

Recommended Reading:

• Rapoport, Judith L.  The Boy Who Couldn’t Stop Washing: The Experience and Treatment of Obsessive-Compulsive Disorder. Signet, 1991. 304 pp. My Comments: This book is perhaps the best volume I have ever read on OCD. Unfortunately, it is nearly eighteen years old. Here’s hoping for an updated edition in the near future! Still, its case studies are priceless in helping both those who suffer and those who don’t understand the disorder. Not to mention that Rapoport is one of the definitive experts in the field.
• Crawford, Mark.  The Obsessive-Compulsive Trap: Real Help for a Real Disorder. Regal Books, 2004. 168 pp. My Comments: This volume is much smaller and more recent than Rapoports’ but lacks the depth of case studies Rapoport’s book provides. Still, it covers most of the bases and is a quick read. It is written from a distinctly Christian perspective.

Attention Deficit (Hyperactive) Disorder:

ADHD is perhaps one of the more common disorders and a polarizing disorder. There is a significant number of individuals who challenge the existence of ADHD, believing it to be an excuse for behavioral and social issues. That said, it affects between 3-5% of children and over 4% of adults according to the NIMH and is Wikipedia describes it as, “is characterized by a persistent pattern of impulsiveness and inattention, with or without a component of hyperactivity.”

Recommended Reading:

• Hallowell, Edward M. and John J. Ratey. Delivered from Distraction: Getting the Most out of Life with Attention Deficit Disorder. Ballantine Books, 2005. 416 pp. My Comments: This volume is extremely readable and informative. Written by two M.D.’s who suffer from ADHD the volume speaks from both personal and clinical experience and covers all aspects of the disorder.
• Hallowell, Edward M. and John J. Ratey. Driven To Distraction : Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood. Touchstone, 1995. 336 pp. My Comments: The original classic volume from Hallowell and Ratey on ADD. If you only want to read one book I’d recommend Delivered from Distraction, if you want to add a second…read the original volume.

Concluding Note:

Recognizing and dealing with what is wrong with ourselves can be huge. It can help us function at a higher level and enjoy life more. It can also be useful when we see these sorts of disorders in others. It can give us a sense of empathy that we might not otherwise be able to experience. The suffering caused by mental disorders while not visible is tremendous, and working together we can significantly increase our own and others overall health by getting the medical help we need and being there for one another.