"On Healing" July 2006

Posted on Mon, Jul. 24, 2006
Opening up to others could rout fear
By Dan Gottlieb

These days the world seems a little more frightening than usual. Iraq feels dangerously out of control. North Korea is firing missiles, Iran is threatening to acquire nuclear weapons, and now Israel and Lebanon have turned into a powderkeg.

Yes, I'm scared. Most of us, when we get together with friends, debate the pros and cons of various interventions. But typically we don't talk about our more vulnerable feelings of fear or helplessness. Usually those discussions are reserved for our closest friends, those whom we trust with our secrets.

And because we are social animals, the larger our network of close friends, the more secure and connected we will feel.

But according to a survey of nearly 1,500 people published in the June issue of the American Sociological Review, the number of people we consider trusted friends has decreased 30 percent in the last two decades.

And 25 percent of us don't confide in anyone. That number has more than tripled since 1984.

Even the authors were surprised by such a dramatic shift over a relatively brief time span.

This study confirms what I've been seeing in my practice, hearing from my radio listeners, and observing around my neighborhood. And I've been asking myself, Why is this happening?

In my view, there are many reasons. Over the last two decades, two working parents have become the norm. As jobs demand more hours, more people sacrifice vacation and sick time. And the relationships we develop at work are rarely of the intimate and confidential kind.

Technology adds to the isolation as more people spend longer periods before a screen. Families move more often and therefore don't have time to develop deep roots in a community. And all that doesn't even mention the children.

So at the end of the day, after carpools and homework and e-mails, with what little energy we have, it's unlikely we're going to spend the evening with some neighbors, let alone join a club to help make the world a better place.

Social isolation exacts a toll. When we don't have trusted friends, we are at more risk for feeling depressed, insecure and disconnected from the larger world. But my question is this: Are you alone with those feelings?

When I admit I'm scared, I know I'm not the only one. I also know that if I add another security system to my home, or move to a gated community, I'll ultimately feel even more isolated and therefore more scared.

What if, instead of withholding our more vulnerable feelings and isolating ourselves, we do the opposite - we begin to open up to additional people in our world?

A young lady I know takes the PATH train from New Jersey to New York for work. This was the train that the terrorists were plotting to blow up. After hearing about the foiled plot, she was terrified to take the train the next day. Not only was she afraid for her life, but she feared she would begin to cry on the train and be embarrassed.

Sure enough, the next day on the train she became so frightened that she began to cry. No one seemed to notice, and one hopes she was less frightened the next day. But I wonder what would have happened if she had said to the person next to her: "I'm a little scared, are you?" Maybe that would have been an opportunity for the other person to acknowledge her own fears. Or it could have let the other person say no, but perhaps put her arm around the young lady. And maybe there would have been some more human contact when and where it was desperately needed.

Posted on Mon, Jul. 10, 2006
Treat the whole life, not the symptoms
By Dan Gottlieb

Road rage is not really road rage. Of course, anyone who has seen that frightening and dangerous behavior might argue with that.

But according to a recent study in the archives of General Psychiatry, it's something called Intermittent Explosive Disorder, and it affects nearly 16 million Americans, more than schizophrenia and bipolar disorder combined.

This was an impressive study involving nearly 10,000 interviews. Intermittent Explosive Disorder is defined as multiple angry outbursts that seem inappropriate to the situation. The behavior typically begins around puberty, and the average number of lifetime episodes is 43.

According to lead author Ronald Kessler, the incidence was much higher than previously thought. They go on to suggest that the disorder is partially a result of inadequate serotonin - the mood regulating brain chemical. So medication and therapies such as anger management can be helpful.

Make sense? Not to me. Much of my continuing education comes from my patients. Granted, I am not examining a sample of 5,000, but I get to learn about people while they are learning about their symptoms.

I recently treated a fellow I will call Joe. A married man with no children, Joe was a kind soul. But often when he felt stressed, he could feel rage building up inside. Although he has never harmed anyone, he has often raged at other drivers.

On occasion, he has become so furious at home that he has thrown dishes and put his fist through a wall. His wife said she used to be terrified; now she just feels sad and helpless.

After the rage, he feels great shame, so he drinks to cope with his feelings. And because he is drinking, he feels even worse. So his fury turns inward and he continues to drink. Eventually, he climbs back on the wagon and returns to his baseline state of kindness.

Charlotte was 14 when I first met her. Like Joe, she was a loving person who would become enraged at what seemed to be the slightest provocation.

Her rages began shortly after puberty. She confided that when this happened, she hated herself and now she is beginning to hate herself all the time. Like Joe, she felt ashamed.

Both Charlotte and Joe had family members who were prone to bouts of anger, so much of their reactivity may have been genetic. And I am sure both were low on serotonin since both were depressed.

I recommended Charlotte see a gynecologist to have her hormones evaluated before we went further. Both saw their doctors and were prescribed medication. Both showed modest improvement. And I am sure if they had received short-term anger management therapy, they would have shown even more improvement.

But there are 16 million people out there with the same problem. Maybe we need to ask bigger questions than which pill or technique to employ.

Here's the problem. Like so many, Joe was living a life that was terribly stressful. He worked too hard at a job he didn't enjoy, slept too little, and deprived himself of joy. And we are learning that continued exposure to the stress hormone cortisol can actually cause depression. So here was Joe, living a life that was unhealthy, and because of his genetics, his unhappiness turned to rage.

Charlotte felt different from the other kids. She felt as though there was something wrong with her. But at school, she pretended she was OK for fear the other kids would make fun of her. This also caused sustained stress, which worsened her depression and made her feel more different. Nobody noticed that Charlotte was suffering; they just noticed her rage.

Do 16 million people have a disorder? I don't think so. But 16 million people may have symptoms that demand attention. When we become enraged more frequently than we would like, it could be our genetics, an undiagnosed depression, or both. But it could also be that we are living lives of not-so-quiet desperation. Please don't ignore your symptoms, but don't simply try to fix them, either. They might be an invitation to take a look at our lives.

The more we treat people's serotonin and ignore their humanity, the more they will suffer. We all will.

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