Stereotypic Movement Disorder [childhood disorder]

Many childhood disorders, especially those of a psychiatric form are controversial in nature.  For one, medicating children is a sensitive topic, which some adults highly disagree with.  In addition, no one wants their child to suffer the stereotypes of having a mental disorder and some may even deny their child has a problem. Studies may even be less conclusive because of the limited amount of years in childhood compared to adulthood. 

Stereotypic movement disorder, which consists of seemingly compulsive, repetitive, and nonfunctional behavior, is thought to occur in 2 to 3 percent of children and adolescents (Sadock, 2003).  While most children show some type of repetitive movements in early childhood, children with this disorder have behaviors that interfere with normal functioning or that cause self-inflicted bodily injury (2003). Stein & Christenson (1998) report this disorder is often overlooked and unseen in most psychiatric literature because it occurs most frequently in children with mental retardation; however, this disorder can occur in children of normal intelligence.

 

Because this diagnosis is often overlooked, it is rarely made (AACAP, 1999).  Stereotyped behaviors are seen frequently in other childhood disorders such as autism, but currently a comorbid diagnosis of both autism and stereotypic movement disorder cannot be made.  There is ongoing controversy over whether these stereotypic movements constitute the addition of an extra diagnosis (1999). In addition, the diagnosis criteria can be interrupted in a manner of ways. Freeman (2006) states one of the main diagnostic problems to occur is “The pattern itself can look indistinguishable from autistic stereotypies, but is much more prolonged than tics. Comorbidty (other disorders) are common, including tics, just to confuse everyone.”  Unfortunately, this disorder is likely under-diagnosed, while other similar disorders may be over-diagnosed.

 

To make matters even more difficult, in Stereotypic Movement Disorder there is a fine line between normal and irregular behavior.  Nail biting for instance, can be considered a symptom; but only when it is severe (Sadock, 2003). Other children exhibit behaviors such as head banging for a period of time, but the problem disappears as the child grows older.  Should they be diagnosed with this disorder? How long should you wait before the diagnosis should be made?  Though the DSM criteria lists “the behavior persists for 4 weeks or longer” (Sadock, 2003), when should body rocking or picking at the skin be considered a real danger? 

All of these aforementioned issues make the diagnostic process for Stereotypic Movement Disorder even more difficult.  Though the vast majority of the population has heard of disorders such as autism or schizophrenia, this disorder is widely unknown in individuals outside of the medical profession.  Further research and publications need to be put into place to raise awareness, and the next version of the DSM may benefit from clarification of this diagnosis.

 

References:

American
Academy of Child and Adolescent Psychiatry (AACAP).  (1999). Practice Parameters for The Assessment and Treatment of Children Adolescents, and Adults With Autism And Other Persuasive Developmental Disorders. Retrieved November 29, 2006 from http://www.aacap.org/galleries/PracticeParameters/Autism.pdf

Freeman, Roger.  (2006). Stereotypic Movement Disorder can be confused with tics and TS. Retrieved November 29, 2006 from http://www.tourette-confusion.blogspot.com/

 

Sadock, Benjamin & Sadock, Virginia. (2003). Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry (9th ed.). Philadelphia: Lippincott Williams & Wilkins.

 

Stein, Dan & Christenson, Gary. (1998). Stereotypic movement disorder: A neglected problem.  Psychiatric Annals, vol. 28, p. 304. 

 

 

 

Methamphetamine dependence

 

Along with the normal criteria for substance dependence, individuals with methamphetamine dependence often present with dysphoria, insomnia, hostility, irritability, restlessness, and confusion (Sadock, 2003). Symptoms may resemble those of an anxiety disorder, but also include paranoid delusions and hallucinations (2003). A patient that comes with flushing or pallor, headache, fever, grinding of the teeth, shortness of breath, tremor, and/or ataxia may be suffering from methamphetamine dependence (2003). In addition, the increase of insomnia and restlessness, along with the decreased appetite, often induces anorexia.

The DSM-IV-TR includes categories for amphetamine-induced mood, anxiety, sleep, and sexual dysfunction disorders. The criterion for methamphetamine withdrawal is the same as that in cocaine withdrawal, as well as that of intoxication.

Sadock, Benjamin & Sadock, Virginia. (2003). Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry (9th ed.). Philadelphia: Lippincott Williams & Wilkins.

Marijuana Dependence

 

The criteria for marijuana dependence can be best illustrated by the normal criteria for substance dependence. While the DSM-IV-TR lists cannabis dependence as a disorder, the only specific criteria it holds is for cannabis intoxication (Sadock, 2003). As in other substance disorders, individuals dependent on marijuana feel as if they must have the drug and will likely abstain from situations where they will be without it for any length of time. The use of marijuana is very controversial, and while it has been proven it produces psychological dependence in heavy abusers, there has not been solid proof that it causes physical dependence. However, cannabis has been known to produce symptoms of anxiety and in rare causes, cannabis-induced psychotic disorder (Sadock, 2003). While some symptoms of anxiety or restlessness may accompany the withdrawal of heavy marijuana use, there is no specific criterion or extreme withdrawal symptoms as seen with other substances.

Sadock, Benjamin & Sadock, Virginia. (2003). Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry (9th ed.). Philadelphia: Lippincott Williams & Wilkins.

Cocaine Abusers

 

When a patient comes in with unexplained personality changes including irritability, lack of concentration, compulsive behaviors, insomnia and weight loss, then cocaine abuse should be considered (Sadock, 2003). Like alcoholics who will only participate in situations where drinking is acceptable or where they can “sneak a drink” in, cocaine abusers frequently run to a private area once or twice an hour to get high.

In some ways, cocaine abuse may be easier to recognize than alcohol abuse because of physical symptoms apparent even when an individual is sober and not experiencing withdrawal symptoms. The most common form of cocaine ingestion, “snorting”, often causes extreme damage to nasal cavity, in which users will often try to self-medicate with nasal decongestants (Sadock, 2003).

As in alcohol abuse, cocaine abuse can also cause psychotic, mood, anxiety, and sleep disorders. Symptoms of withdrawal include fatigue, unpleasant dreams, insomnia, increased appetite, or psychomotor irregularities (Sadock, 2003). Withdrawal symptoms are apt to be much less severe than those seen in heavy alcohol abusers, and with mild or moderate abuse, regularly reside within 18 hours (2003).

Sadock, Benjamin & Sadock, Virginia. (2003). Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry (9th ed.). Philadelphia: Lippincott Williams & Wilkins.

Alcohol Dependence

 

Individuals suffering from alcohol dependence will experience an intense craving for alcohol, regardless of the hazardous effects they are experiencing due to its use. Once alcoholics start drinking, it becomes very difficult for them to stop. When they do stop for any period of time, withdrawal symptoms will occur (Sadock, 2003). Once a person has reached a tolerance to alcohol, he or she has to drink more and more to get the same “buzz” or “high”.

Alcohol becomes a person’s “best friend” and starts to take the place or other things that were once important: friends, family, career, church, hobbies, etc. Individuals with alcohol dependence may sustain from going anywhere alcohol is not allowed and plan their day around alcohol. However, they may hide a bottle or liquor in their attire and frequently retreat to a place where they can drink.

While most individuals who use, but don’t abuse, alcohol drink on special occasions or during dinner, for example; alcoholics will likely wake up with the urge for an alcoholic beverage as a substitute for coffee, per say. Whereas the occasional drinker likely enjoys the company of others while drinking, the alcoholic often drinks alone because he or she does not want others to know about his or her problem.

The need for alcohol is easily induced by stressful situations. Many alcoholics feel ill at ease, and not just physically, when they are without a drink. Guilt often arises, but this normally causes an individual to drink even more so they no longer feel responsible for their actions. Becoming extremely intoxicated to the point of experiencing blackouts is common for individuals suffering from alcohol dependence (Sadock, 2003). This dependence often leads to a plethora of problems- DUIs, spousal or child abuse, etc.

When alcoholic dependent individuals are required to abstain from drinking, the withdrawal symptoms can be severe. Tremors, nausea or vomiting, increased heart rate, insomnia, hallucinations, anxiety, and even seizures can occur (Sadock, 2003). Many mental disorders, including persisting amnestic disorder, psychotic disorder, anxiety disorder, and sleep disorder, can be caused by alcohol dependence (2003). When a history of excessive alcohol use is apparent or suspected along with a mental disorder, clinicians should create a time-line to differentiate whether the alcohol or mental disorder arose first to establish the correct treatment plan.

Sadock, Benjamin & Sadock, Virginia. (2003). Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry (9th ed.). Philadelphia: Lippincott Williams & Wilkins.

When Does the Diagnosis Change from Substance Use to Abuse or Dependence?

 

When the excessive desire and intake of a substance causes the loss of a job, divorce or marital discord, imprisonment or arrest, financial hardship, mental or physical health deterioration, or other noteworthy difficulties, then the situation should no longer be categorized as substance use. When a person experiences social difficulties due to a substance, but no health or psychological problems, then he or she is likely suffering from substance abuse. When tolerance or withdrawal occurs simultaneously with social impediment, then the diagnosis of substance dependence is to be expected. There has been much debate regarding the real difference between substance abuse and dependence; and there is a fine line between the two, though they both cause substantial tribulations. However, when a person actually depends on a substance on a daily or hourly basis, physically or mentally, in a way that nothing else will suffice, then substance dependence is warranted.

Distinguishing Characteristics of Substance Use, Abuse, and Dependence

The term substance use can be defined as the intake through various means of both legal and illegal substances with the intention of producing a different state of mind or overall feeling, also known as “getting high”. In this context, the word “substance” has become the replacement for the word “drug”, because “drug” implies a manufactured chemical (Sadock, 2003). Substances such as opium or spray paint are often used to get high, but do not fit the technical criteria for the term “drug”. The topic of substance use is controversial in many respects; including, but not limited to, the areas of government religion, and the legal system.

If an individual has never met the criteria for substance dependence, but his or her substance use leads to social consequences, including the failure to complete responsibilities at school, home, or work; continual substance use in hazardous situations; recurrent legal problems related to substance use; or sustained substance use albeit experiencing persistent problems caused or aggravated by the effects of the substance, then he or she is suffering from substance abuse (Sadock, 2003).

While substance abuse is typically exposed by the social difficulties involved, substance dependence is related to the physiological and behavioral symptoms, commonly known as addiction. To meet the criteria for substance dependence, an individual must be experiencing impairment or distress in three or more of the following areas within a year (Sadock, 2003):
A. Tolerance: needing an increase in dosage to experience the same effect
B. Withdrawal: meeting the criteria for withdrawal or taking another substance to suppress withdrawal symptoms
C. Often taking the substance in excessive amounts or for a lengthy period of time
D. Having a constant desire or failed efforts to abstain from the substance
E. Spending an extensive amount of time in acquiring, using, or recovering from the substance
F. Reduction or absence in meaningful activities due to the substance use
G. Sustained substance use even after experiencing physical or psychological problems caused or aggravated by the effects of the substance
Substance abuse is often the precursor for substance dependence. However, in some cases, substance abuse may never turn into full-fledged substance dependence; likewise, preexisting substance abuse is not a requirement for substance dependence (Medical, 2003).

Disorganized or Residual Schizophrenia

The presentation of an individual with disorganized schizophrenia compared to one with residual schizophrenia will likely be quite opposite. A patient with disorganized schizophrenia will probably appear unkempt and display an inappropriate, silly, and childlike behavior (Sadock, 2003). They may laugh at the most serious of statements, as well as grinning and grimacing frequently. However, the extreme happiness may develop into extreme rage very quickly. The emotional liability of these patients is high. Before sedated or restrained, these patients may seem very anxious because of their constant activity, which normally consists of meaningless and often repetitive movements. Their speech will also come across in the same fashion. Though fairly spontaneous, it is normally unintelligible and may include rhyming and clanging. The break with reality is generally intense; and delusions and hallucinations may also accompany (2003).

On the other hand, someone with residual schizophrenia may seem to be withdrawn and show little emotions about anything (Sadock, 2003). They may appear very passive and even depressed because of their lack of initiative in speech or behavior. Speech is normally understandable, unlike in disorganized schizophrenia. However, one may link completely unrelated thoughts together or use nonverbal communication when possible. These patients usually have strange mannerisms or ways of thinking. They may wear eccentric clothing or have peculiar philosophies. Positive symptoms are very mild or infrequent. While delusions and hallucinations can occur, these are not prominent (2003).

While individuals with the paranoid schizophrenic subtype normally have a better prognosis, there is little variation on prognosis by subtype alone. If this was the first hospitalization for each patient, I would start by explaining the general prognosis for schizophrenia. I would inform them that only ten to twenty percent have a favorable outcome, but that the disorder does not always run a debilitating course (Sadock, 2003). In addition, I would tell them it is likely that their family member will have to be readmitted to the hospital within the next two years even with treatment.

After the general prognosis is described, I would then look at some of the other factors affecting the patient. If the patient is extremely young, has a family history of schizophrenia or perinatal trauma, a prior history of violence, or primarily negative symptoms (as seen in the residual type), then the outlook is probably going to be poor. I would then inform them that having the support or a family, friends, or spouse will improve the prognosis. On the other hand, if the patient is older, has a sudden onset, a positive social history, affective symptoms, or positive symptoms then I would say the prognosis is going to be brighter.

Reference:

Sadock, Benjamin & Sadock, Virginia. (2003). Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry (9th ed.). Philadelphia: Lippincott Williams & Wilkins.

Schizophreniform vs. Schizoaffective Disorder

Schizophreniform and schizoaffective disorders share many of the same characteristics, but the main difference is that schizophreniform disorder is characterized by primary symptoms of schizophrenia, while schizoaffective disorder has to include both schizophrenic and mood disorder characteristics. In schizophreniform disorder, either no major affective episodes have occurred during the active phase of symptoms, or their total duration has been brief (Bhalla, 2006), compared to schizoaffective disorder where the affective symptoms must have occurred for a significant part of the disorder normally at a minimum of 15-20% (Sadock, 2003).

For an individual to be diagnosed with schizophreniform disorder, the symptoms of psychosis, those affecting speech and behavior, and the negative symptoms will last at a minimum of one month. To be diagnosed with schizoaffective disorder, a patient only has to have psychosis for 2 weeks without symptoms of a mood disorder (Sadock, 2003).

Both disorders have a prognosis somewhere between schizophrenia and mood disorders (Sadock, 2003). While schizophreniform disorder has an equal distribution among the sexes, schizoaffective disorder is more predominant in women. The age of onset, in early adulthood, is comparable in both disorders (2003). Schizoaffective disorder is thought to be around 2.5 to 4 times as prevalent as schizophreniform disorder, 0.2% to .05-.08%. Perhaps this is because the majority of schizophreniform cases evolve into schizophrenia before consultation?

Individuals with schizophreniform disorder can have the same symptoms as those with schizophrenia, but the symptoms must only last between one to six months. However, the onset in schizophreniform disorder is usually more rapid than that of schizophrenia. Unfortunately, sixty to eighty percent of patients with schizophreniform disorder progress to full blown schizophrenia (Sadock, 2003), while this does not seem to be the case in schizoaffective disorder.

While there is much disagreement about whether schizophreniform and schizoaffective disorders should have two different sets of criteria, the different methods of treatment support the idea that these disorders are separate occurrences. In schizophreniform disorder, the mainstay of treatment is an atypical psychotic for a period of three to six months (Sadock, 2003). In schizoaffective disorder, a combination of anti-depressant and anti-psychotic for the depressed subtype, or a combination of mood stabilizer and antipsychotic is utilized for the manic subtype (Brannon, 2005). This coincides with the criteria that schizophreniform is composed of primarily schizophrenic symptoms, while schizoaffective disorder is composed of both schizophrenic and mood disorder symptoms.

If someone presented with his or her first episode of symptoms that resolved within six months, the diagnosis would still be based on the symptoms themselves. Schizophrenia is automatically ruled out because of the short length of time, but either schizophreniform or schizoaffective diagnoses could be made. Though it would be easy to jump to the conclusion that the patient was experiencing schizophreniform disorder, someone with schizoaffective disorder could be in remission. In the patient has an equal, or significant, proportion of mood symptoms occurring along with the schizophrenic criteria, then a diagnosis of schizoaffective disorder would be warranted. Otherwise, the diagnosis would be schizophreniform disorder.

References:

Bhalla, Ravinder. (2006). Schizophreniform Disorder. Retrieved November 15, 2006 from http://www.emedicine.com/med/topic3350.htm

Brannon, Guy E. (2005). Schizoaffective Disorder. Retrieved November 15, 2006 from http://www.emedicine.com/med/topic3514.htm

Sadock, Benjamin & Sadock, Virginia. (2003). Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry (9th ed.). Philadelphia: Lippincott Williams & Wilkins.

ADHD Diagnosis Controversy

While the majority of clinicians and health agencies recognize ADHD as a real disorder, there is a great deal of ongoing controversy within the general public. A Frontline television program entitled “Medicating Kids” showcased some of these controversial views (Gaviria, 2001). One interviewee, Fred Baughman, has been a child neurologist for 36 years and is an active opponent of the ADHD diagnosis. Baughman says while the American Psychiatric Association views ADHD as a neurobiologic disorder, the psychiatry field has never “validated ADHD as a biologic entity” (2001). He also declares that these children are all normal and it is the parents and teachers who do not want to accept the responsibility for being unable to control the child. Russell Barker, a professor of psychiatry and neurology at the University of Massachusetts and another interviewee, continues with the discussion of parent responsibility (2001). Barker states:

But there’s also concern because ADHD is a disorder that appears to violate a very deeply held assumption that laypeople have about children’s behavior. All of us were brought up believing, almost unconsciously, that children’s misbehavior is largely due to the way they’re raised by their parents and the way they’re educated by their teachers. If you wind up with a child who is out of control and disruptive and not obeying, that that has to be a problem with child rearing. … Well, along comes this disorder that produces tremendous disruption in children’s behavior, but it has nothing to do with learning, and it isn’t the result of bad parenting. And therefore it violates these very deeply held ideas about bad children and their misbehavior (Gaviria, 2001).

This statement by Barker provides a valid explanation for the continuous controversy over whether ADHD is, in fact, a real disorder. In opposition to Baughman’s opinion, Barker states that ADHD is a valid condition; and if other mental disorders such as Schizophrenia, Bipolar Disorder, etc. required proof, there would be no such thing as psychiatry (2001).

Peter Jensen, the head of child psychiatry for the National Institute of Mental Health, attributes much of this controversy to the fact that “there isn’t good consensus about the best way to draw the boundaries between ADHD and other syndromes” (Gaviria, 2001).
Another article also states that critics of the diagnosis argue that the criterion is vague enough to allow most children to be diagnosed with this disorder (Answers, 2006). For example, psychiatrist Simon Sobo M.D. disputes that the symptoms of ADHD depict children when they are uninterested and unconnected to a task (2006).

There are many other reasons for the controversy surrounding the ADHD diagnosis. Some individuals conclude that teachers consider any child who cannot be controlled in the classroom to have ADHD, while others go on to say that these stimulants given to children diagnosed with ADHD have an affect on anyone (Answers, 2006). Regardless, the psychiatry field supports the diagnosis of ADHD. The aforementioned concerns may be valid and too many children may receive the diagnosis of ADHD. However, there is overwhelming evidence some individuals are affected with ADHD, and that the diagnosis is real.

References:

Answers Corporation. (2006). Controversy about ADHD. Retrieved November 22, 2006 from http://www.answers.com/topic/controversy-about-adhd

Gaviria, Marcela. (2001, April 10). Medicating Kids [Television broadcast]. Boston, MA: Frontline of WGBH.

National Institute of Mental Health (NIMI). (2006). Attention Deficit Hyperactivity Disorder. Retrieved November 22, 2006 from http://www.nimh.nih.gov/publicat/adhd.cfm#intro

ADHD Diagnosis Difficulties

 

As most all children have periods of restlessness, impulsivity, and daydream from time to time, diagnosing ADHD can be difficult (NIMH, 2006).  Symptoms vary so much in different situations, which can make this diagnostic process even harder, especially when the primary symptom in inattentiveness. However, whenever these behaviors start affecting school performance or relationships with other children, for example, ADHD may be suspected. Due to this difficulty, the diagnostic process requires behavior that is inappropriate for the child’s age, and as aforementioned, have at least 2 areas of life affected by these behaviors (2006).  If either schoolwork or family life is the only thing affected, then a child should not be diagnosed with ADHD. In addition, clinicians should check to make sure these behaviors are not situational.  For example, a child may begin to show inattentiveness if a family member dies or his or her parents are divorced.  Medical problems should also be considered such as petit mal or temporal lobe seizures, hearing problems, or a different type of learning disability (2006).

 

National Institute of Mental Health (NIMI). (2006). Attention Deficit Hyperactivity Disorder.  Retrieved November 22, 2006 from http://www.nimh.nih.gov/publicat/adhd.cfm#intro

ADHD Subtypes

There are three recognized subtypes of ADHD:  hyperactive-impulsive type (does not show noteworthy inattention), predominately inattentive type (does not show noteworthy hyperactive-impuslive behavior), and the combined type (displays both inattentive and hyperactive-impulsive symptoms) (NIMH, 2006). Children with the hyperactivity-impulsivity type seem to be in constant motion, whether it be with talking, fidgeting, touching everything, etc. Impulsive children may utter inappropriate comments, be unable to wait their turn, and require immediate attention (2006).   Children with the inattentive type may get bored very easily, causing them to skip from one activity to another, become distracted by sounds or other irrelevant things, make careless mistakes, or forget things needed to complete a certain task.  These children, suffering from the inattentive type, are often overlooked because they may be very quite, get along sufficiently with other children, and appear to only be daydreaming (2006). 

National Institute of Mental Health (NIMI). (2006). Attention Deficit Hyperactivity Disorder.  Retrieved November 22, 2006 from http://www.nimh.nih.gov/publicat/adhd.cfm#intro

ADHD Overview

 

 

ADHD, or Attention-Deficit Hyperactivity Disorder, affects approximately 3 to 5 percent of children (NIMH, 2006).  Inattention, hyperactivity, and impulsivity are the three primary symptoms of the disorder, which can appear over many months. Various situations may cause an exacerbation of different symptoms (2006).  Teachers are often the first individuals to recognize a child’s symptoms, because a parent may think all children go through “phases” such as this. For a child to be diagnosed with ADHD, their symptoms must appear before the age of 7, consist for at least 6 months, and create a handicap in two areas of the child’s life (such as in the schoolroom and in social situations) (2006). 

National Institute of Mental Health (NIMI). (2006). Attention Deficit Hyperactivity Disorder.  Retrieved November 22, 2006 from http://www.nimh.nih.gov/publicat/adhd.cfm#intro

Schizophrenia: An African American Epidemic

Causes, Effects, and Resolutions for Misdiagnosis of

African Americans in the Mental Health Sector

 

This is an introduction to a lengthy paper. 

If you would like to read the rest of this paper, please click on the link below.

Misdiagnosis of Schizophrenia in African Americans

 

Abstract

Many studies have shown that African Americans are frequently misdiagnosed with schizophrenia, but the reason for this disparity is still unknown. Contributing causations may be symptom misinterpretation, lack of research, and bias, to name a few. Misdiagnosis harms a plethora of African Americans each year due to improper treatment and the effects thereof. Researching what factors play a role in the misdiagnosis trend, as well as implementing cultural competency standards and education for mental health professionals should be the first steps taken to ensure African Americans have the right to equal mental health treatment. 

Introduction

          In the United States society, the ill-treatment of people of color is manifest in health conditions (National Association of Social Workers [NASW], 2001). Accordingly, the psychiatric treatment of African Americans has been carried out on an institution of stereotypical views toward their racial group (Feagin, Early, & McKinney, 2001). Over 18 million adult Americans develop a mood disorder each year, whereas only two million, or a mere one percent of the U.S. population, develops schizophrenia (Kimmon, 2005). How is it, then, that African Americans with mood disorders or depression are more often than not diagnosed with schizophrenia (Kimmon)?  Does the African American race have a greater tendency to develop schizophrenia?

          Actually, it seems to be quite the contrary. Non-biased studies have shown once factors such as socioeconomic status are taken into account, there are comparable rates of schizophrenia in Caucasians and African Americans. Even so, the pattern of schizophrenic misdiagnosis is more prevalent in African Americans (Colorado Department of Public Health and Environment [CDPHE], 2005). “Research has already shown that African American patients are being improperly diagnosed, but we need to find out why” (Kimmon, 2005).

Family and Friends of Individuals with Bipolar Disorder

Family and friends may be able to provide more accurate information about the patient’s mental condition than the patient themselves.  While they may not know what the patient is feeling, they can give an account of the patient’s behavior from day to day.  In addition, co-workers, instructors, and individuals who frequently come into contact with the individual may provide significant details pertaining to his or her condition. 

If it is confirmed that a patient has family members with a mental disorder, especially immediate family members with bipolar disorder, than the chances of inheritance are great.  Sometimes a genetic link may be the most significant clue of a full-blown or impending case of bipolar disorder.  If a patient has a parent with bipolar disorder and presents with symptoms of depression, then special attention should be given. Bipolar I disorder often begins with depression, so even if mania has not yet arisen, the individual should be carefully monitored for signs of extremely elevated or irritable moods.

 

Bipolar disorder is a difficult disorder to both diagnosis and to live with.  Family members are often affected as much as the patient.  Children with a bipolar parent may live in constant fear of their parent’s extreme mood swings and bear the major blunt of the disorder.  Many times a child may feel it is his or her fault when a parent is depressed or that he or she did something to cause the parent to become angry.  Spouses have it no easier.  The destructive behavior manic patients often engage in may have serious consequences, not just for themselves, but to their relationship as well.  A manic individual may desire sexual intercourse constantly or engage in dangerous sexual practices.  A family may go bankrupt due to a manic induced spending spree. A manic individual may be extremely volatile and have violent outbursts over the most insignificant things. 

 

When a patient comes off of a manic high, the situation is no better.  Depression is almost inevitable, and the consequences of their manic episodes often arise, causing an even deeper form of depression.  Considering how frequent suicide is in patients with bipolar disorder, families may live in a constant state of worry.  If an individual does commit suicide, family members often blame themselves as well.  Family members of individuals with bipolar disorder often experience mental disorders, even when there is no genetic link. The stress and anxiety of trying to take care of, and live with, a bipolar individual is great.  A clinician should not only assess a patient with bipolar disorder, but the family members as well.    

Diagnosing Bipolar Disorder

Bipolar Disorder is often a difficult syndrome to diagnosis.  Patients are much more likely to seek treatment when suffering from depression than mania, and many times patients may be less than truthful when discussing their “highs”, whether intentionally or unknowingly.  While a psychiatrist may easily see symptoms of bipolar disorder when a patient is treated over a long period of time, misdiagnosis is frequent on the first visit.  Often times, an inexperienced clinician may view a person experiencing mania or hypomania as a very happy, lively, and enthusiastic individual.  Manic patients’ moods can be very infectious. 

Paying close attention to speech and body language is an important diagnostic tool. Patients with depression may speak slowly and quietly with their heads down, have a flat-tone, and show little emotion. Men may appear unshaven. Clothing may be wrinkled, and patients may have an overall downtrodden look. On the other hand, manic patients may talk quickly and loudly, frequently using jokes or puns. Their speech may be incoherent or consist of a “flight of ideas”, jumping from one topic to the next.  Often provoked to anger, the simple suggestion of mania may cause a patient to become irate.  Clinicians must be aware of the emotional unstableness of manic patients because violent outbursts are common.

As manic patients are often unaware of the mental state they are in or have previously been in, getting an accurate history of the patient may be difficult.  While lying may be intentional because a patient is experiencing a “high” and does not want to come down, individuals may not be able to give a truthful account, regardless of their sincerity. Clinicians should try to gather information such as past medical records, criminal incidents, and job history. Inability to maintain a job, especially when performance was satisfactory for a length of time, may be an indicator. Also, sexually transmitted diseases, and maxed-out credit cards may be consequences of a manic episode. Substance abuse, which is common in bipolar disorder, should be taken into consideration as well.

Case Study and Hypothetical Explanation

Bill is a middle aged, married, Caucasian male who has two grown children. Bill’s father passed away when Bill was in college, and this loss still pains him. He held his father in extremely high regard and at times referred to him as “brilliant” even though his father did not graduate from high school. His father worked at a skilled trade until he suffered a fatal illness in his late 40s or early 50s. Bill laments the loss of his father and, in particular, the guidance he thought his father could have provided during turbulent times in Bill’s life. According to the pattern of alcohol use that Bill describes, it is likely that Bill’s father had a serious drinking problem, if he was not actually an alcoholic. His mother, who is also dead, is described by Bill as a strong woman and the matriarch of the family. While he states that he had much respect for her, it seems that his respect was also tinged with fear of her disapproval. She never accepted or understood why he chose the college he did and why he had an interest in an Army career.Bill states that his mother never used alcohol. He describes her as a very critical and judgmental person. His family of origin was devout in their religious beliefs, and this appears to play a significant role in his life. He is close to his siblings, but they do not talk often, and he feels guilt for not initiating calls to them. His hesitation to call them is due in part to a fear that they will reject him. It is for this reason that he also tries to keep conversations with them at a superficial level. His extended family includes people who have achieved at the highest levels of government and their professions.Bill graduated from a prestigious college and embarked on a military career, which was his lifelong ambition. A “vindictive” superior officer who gave him poor performance evaluations cut this short. It turns out that Bill may have had much more of a role in this than he admits initially or is aware of. He acknowledges a lengthy period of indecision and marginal adherence to military standards at the beginning of his career. Nonetheless, he developed the persona of hero in both military matters and civilian jobs, and to this day, he compares himself with heroic figures from antiquity and sees himself on the verge of doing something great.Since his discharge from the Army, he has held at least five or six jobs in which he seemed to do well, until he was ultimately fired for reasons that are not entirely clear. It appears that the terminations were due to personality conflicts or nepotism by the owner of the business. He has been unemployed for the last three years. Bill is frightened about applying for another job because of the possibility of rejection or failure (being fired again).Bill places unrealistic importance on the support available from his nuclear family. Yet, he says he is cautious around them because if he says or does the wrong thing they might leave him or tell him to leave. He expresses anger at his adult children because they do not appear as devoted to him as he was and still is to his late father. However, he keeps this anger to himself for fear of rejection. He also experiences this conflict with his wife of many years. It is not possible for her to meet his expectations for support, so he becomes angry with her, but withholds the expression of his anger for fear of alienating her.

He has great difficulty getting out of bed in the morning and constantly thinks about suicide. While he feared death as a young man, now he says he would welcome it. He has been on psychotropic medication for years and questions whether it is working. Bill is awash in guilt. He feels guilt for things he has done and things he has not done. He has a disarming smile that belies the pain he feels and keeps people from prying into his life. He has one or two drinks of Jack Daniels neat each night. Psychotherapy is difficult with him because of the chronic nature of his problems and his fear of alienating people who are close to him. He seems to genuinely believe that his expectations of other people are fair and reasonable.

 Hypothetical Explanation:

Axis 1: 1.  Major Depressive Disorder, Moderate

One of the primary symptoms of Major Depressive Disorder is a depressed mood, most of the day, occurring nearly every day.  Though we do not have a detailed account of Bill’s history, it seems as if he never got over the death of his father. It appears that Bill believes if only his father were still alive that he would be able to cope and get through the “hard times”, but that he is not capable of this due to his father’s death.  His father’s death may have been the starting point of his depression.

Only three percent of patients suffering from depression do not experience reduced energy, difficulty finishing tasks, or impaired functioning at work or in school (Sadock, 2003).  Bill’s loss of his military career may have been a precursor to his depression; and his inability to keep a job, as well as his three-year stretch of unemployment, may have been a consequence of Major Depressive Disorder. Though we do not have a complete history of Bill’s depressive symptoms, considering his marital discord, it is likely that he also has a diminished sexual relationship.

Individuals with Major Depressive Disorder often suffer from feelings of excessive or inappropriate guilt; Bill does both.  He constantly feels guilty about things he has and hasn’t done. He states he is “awash” in guilt.  He fears to call his siblings, but feels guilty when he doesn’t.  This anxiety Bill experiences, which is present in 90 percent of cases (Sadock, 2003), is a common occurrence in this disorder.

Bill also complains about getting out of bed in the morning.  Patients with depression often complain of sleeping difficulties.  Either an excessive amount of sleep is needed, or insomnia is present.  This excessive need to sleep that plagues Bill is most likely related to diminished interest in every-day activities.  Bill has trouble with getting out of bed because he feels he has nothing to look forward to and that it will be another painful day.

The most dangerous, and perhaps severe, symptom of depression is suicidal ideation. Suicide is a definite warning sign for patients with severe depression.  Around two-thirds of all depressed individuals consider suicide, and tragically ten to fifteen percent actually commit the deed. Bill’s constant thoughts of suicide need to be addressed immediately.   

2.  Alcohol Abuse

Bill reports a drinking habit of one to two drinks a night.  This would put Bill in the category for “moderate drinking” (Sadock, 2003) and would not necessarily indicate he has a drinking problem.  However, considering his father, who he seemed to idealize, likely had a severe drinking problem, the chances are strong that Bill has the tendency to be a victim of alcohol abuse.  Studies have shown that having a parent who is affected by an alcohol-related disorder increases the chance that the child will also develop a similar disorder later in life (2003).  In addition, individuals with an alcohol disorder, especially when combined with Major Depressive Disorder, are at a greater risk of committing suicide (2003).  This problem should be addressed immediately, before it worsens or couples with the depression to produce hazardous effects.

Axis 2: Passive-Aggressive Personality Disorder

Though it is quite evident Bill is likely suffering from a personality disorder, it is difficult to accurately determine the correct diagnosis due to inadequate information and varying symptoms.  Bill has some features of Narcissistic Personality Disorder and Avoidant Personality Disorder.  However, with the description given, Passive-Aggressive Personality Disorder seems to be a good fit. This disorder cannot solely occur during Major Depressive Disorder, but unless Bill’s depression began before his military career ended, it does not seem to be exclusive to his depression.

Bill’s entire demeanor seems to consist of much anger and brooding, but with little expression of his emotions.  After Bill’s initial loss of his military career, he was not successful in keeping a job, and he gave up because of fear he would fail or be rejected once again.  This could fall under the symptom of “passively resists fulfilling routine social and occupational tasks” (Sadock, 2003). He speaks of his commanding officer as “vindictive” and though the cause of his other terminations is unknown, he attributes being fired to favoritism or bias by his employers (“voices exaggerated and persistent complaints of personal misfortune”, 2003).  Individuals with Passive-Aggressive Personality Disorder often scorn and irrationally criticize authority (2003).  This seems to be the case with Bill.  He blames his commanding officer for his military problems, but does admit to having little to no adherence to military rules during the beginning of his career.

Bill appears to be in utter turmoil with himself; one minute he is full of guilt and the next he is angry and blaming others for letting him down. Alterations between remorse and insubordination are common in Passive-Aggressive Personality Disorder. It is very likely this is the reason for his career failure.  Considering his performance looks to be adequate in all of his job endeavors, the “personality conflicts” Bill speaks of must have great significance.

His personal relationships are no more successful.  He is constantly at odds with his family (“complains of being misunderstood and unappreciated by others”, Sadock, 2003).  He has unreal expectations of the support they should give him. He stays angry at his wife because she doesn’t support him in the way he feels she should, and also feels scorn towards his children because they are not as devoted to him as he feels he was, and is, to his father.

Even though Bill has a great amount of anger, he does not express this anger for fear of rejection.  In addition, he rarely calls his siblings because of this fear of rejection and feels guilty when he doesn’t; yet, when he does, he only discusses superficial topics because he is afraid of getting hurt.  These latter characteristics of fear of rejection and intimate relationships could be described as features of Avoidant Personality Disorder.  Bill tries to avoid any kind of relationship or activity that he could possibly experience rejection in again. Bill speaks of fear of his mother’s disapproval and describes her as being “critical and judgmental”. Bill’s fear of rejection likely stemmed from childhood, but grew stronger when additional rejection occurred.     

Another feature that seems somewhat out of character with Bill’s other symptoms is his narcissistic, grandiose sense of self-importance.  While working in the military and other positions, Bill started to see himself as a hero and “on the verge of doing something great”. While it may seem somewhat odd that Bill is so depressed when he has such a high regard for himself, Edward Bibring describes depression as an occurrence that begins when an individual becomes conscious of the incongruity between extremely lofty standards and the incapacity to meet these objectives (Sadock, 2003).

Axis 3:  No Diagnosis.

There is no physical health issue presented, but this possibility cannot be ruled out until a full medical workup is completed.

Axis 4: Loss of Career/Unemployment and Family Dissension

Individuals who are unemployed are three times more likely to suffer from depression (Sadock, 2003).  Bill pursued a military career even after the disapproval of his mother, and the disappointment of losing this position had to have a major effect on him.  Not only did Bill lose one job, he lost half a dozen others. This type of failure is enough to cause a mentally stable individual substantial turmoil. 

In addition, it sounds as if Bill has always had problems with his family life.  Though he speaks highly of his father, the possibility that he was a severe alcohol abuser should be taken into consideration.  He expresses his mother as being “devout in her spiritual beliefs” and never using alcohol. This likely caused conflicts between his parents. Regardless, Bill conveys the fear he had of his mother. Progressing to his married life, Bill has had problems with marital discord, little contact with siblings and feelings of abandonment by his children.

Axis 5:  GAF = 35

The GAF rating between 31-40 is defined as “some impairment in reality testing or communication OR major impairment in several areas, such as work or school, family relations, judgment, thinking or mood” (Sadock, 2003).  Bill has substantial impairment in his professional and social life, along with suicidal ideations.

Sadock, Benjamin & Sadock, Virginia. (2003). Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry (9th ed.). Philadephia: Lippincott Williams & Wilkins. 

Description of Bipolar Disorder

Bipolar disorder, which was once termed manic-depressive disorder, is a mood disorder that affects around one percent of the population.  Unlike major depressive disorder, the prevalence of bipolar disorder is the same in men and women.  However, men are more likely to suffer from manic episodes and women from depressed episodes.  When women do experience mania, they are more liable to experience mixed episodes and rapid-cycling. Five to fifteen percent of individuals with bipolar disorder experience rapid-cycling, or having four or more manic episodes in a year (Sadock, 2003).

Two irregular mental states, depression and mania, are the hallmarks of the syndrome. A mixed episode, which meets the criteria for mania and major depression, may also occur.  The symptoms of depression displayed in bipolar disorder are consistent with that of major depressive disorder, including a depressed mood, weight loss or decreased appetite, fatigue, insomnia or hypersomnia, feelings of worthlessness or guilt, psychomotor agitation or retardation, a diminished ability to think, recurrent thoughts of death, and diminished pleasure in activities (Sadock, 2003).

 

Mania is defined as an abnormally elevated, irritable, or expansive mood lasting for a period of a week or longer (if untreated, three months on average) that causes marked impaired functioning. The normal onset is rapid- a few hours or days, but the state may evolve over a few weeks (Sadock, 2003). Symptoms include distractibility, a flight of ideas, a decreased need for sleep, increased talkativeness, inflated self-esteem, an increase in goal-directed activity or psychomotor agitation, and an excessive involvement in possibly detrimental, pleasurable activities (2003).  In severe cases of mania, psychotic features may be present, including delusions or hallucinations.  Patients with mania, especially those with psychotic features, may need hospitalization to keep from harming themselves or others. 

Patients with hypomania, a less severe form of mania, experience similar symptoms to those with mania, but do not have impaired functioning.  Episodes only have to last for four days or more rather than a week, hospitalization is not necessary, and psychotic features are not present (Sadock, 2003).  Even so, symptoms are noticeable by others and individuals in a hypomanic state have an unmistakable heightened level of functioning.

 

There are two main categories of bipolar disorder, Bipolar I and Bipolar II disorder.  To be diagnosed as having Bipolar I, a patient must have experienced at least one manic mood and one episode of major depression or a mixed episode. Bipolar I normally commences with depression; and the earlier the onset, the poorer the prognosis (Sadock, 2003).  Fortunately, around seven percent of individuals with Bipolar I disorder do not have a recurrence of symptoms. However, around a third of patients have persistent symptoms and social decline (2003). The criteria for Bipolar II disorder consists of at least one major depressive episode and hypomanic episode, without any periods of mania or mixed episodes.  Unlike Bipolar I disorder which may have permanent remittance however infrequent, Bipolar II disorder is a chronic, long-term disease. 

To read the symptoms of bipolar disorder is one thing; to experience them is a totally different situation.  Imagine being on a roller coaster. When the coaster is sitting still, the patient is stable, but may very well have an impending sense of dread for what is about to happen. Then the roller coaster starts climbing the hill.  One could equate this to the evolution of a manic episode.  Sleep starts to diminish and the mood starts to elevate.  The “rider” no longer has a sense of dread because he or she gets excited, elevated, and feels as if he or she can do anything. Then the ride truly begins.  Thoughts start flowing rapidly and the individual wants everyone to feel what he or she is feeling and has a desperate “need” to talk to anyone who will listen.  Things are truly wonderful and the world is a nice place to live.  However, once the ride goes on for a while, things begin to get confusing.  Everything seems to be rapidly flying past, but things start to make less and less sense.  Words don’t come out as fluently and this sense of elevation starts to become a source of extreme irritation. Everything starts to become exasperating.  Then the ride slowly comes to a stop.  The sense of elevation suddenly ends and the excitement is over.  After such a ride and being able to accomplish so much, what is left?  Every day life seems boring and thoughts are still muddled. The individual no longer wants to be around anyone because he or she has nothing to say.  Words don’t come out right anymore, and no one can understand what they are feeling. The only thing left is death because he or she no longer has anything left to give.  Of course, this is only a simplistic analogy of some of the symptoms patients experience when bipolar, but hopefully it provides a little insight into the disorder.

Anxiety Symptoms in Hypothyroidism

Hypothyroidism, one of the most common endocrinological conditions associated with anxiety (Hall, 2002), is a state in which the body does not produce enough of the thyroid hormone (EndocrineWeb.com, 2005). One of the most common causes of hypothyroidism is autoimmune thyroiditis, also known as Hashimoto’s thyroiditis, which is an inflammation of the thyroid gland caused by an individual’s own immune system.  This inflammation will damage or destroy cells, leaving them incapable of producing an adequate amount of hormones (2005).  However, there are other causes, for i.e. individuals that do not produce enough hormones due to a problem with the pituitary gland (2005).

The main diagnostic tool for hypothyroidism is a blood test; if the thyroid hormone (TH) level is below normal range, then a patient most likely has hypothyroidism (EndocrineWeb.com, 2005).  Normally, an individual will have a high thyroid stimulating hormone (TSH) level along with a low TH level because the pituitary gland is trying to overcompensate for the lack of TH created (2005).

There is a wide range of severities within hypothyroidism, and the severity of symptoms does not always correlate with the severity of the disorder (EndocrineWeb.com, 2005). Some common physical symptoms are fatigue and lethargy, diminished libido, headaches, weakness, cold intolerance, and dry skin; physical signs include thin, course hair, pallor, brittle nails, and a slowed pulse (Hall, 2002).  Once the disease progresses, vision and hearing deficiencies, weight gain, inability to sweat, muscle cramps, and several other symptoms often arise.

Psychiatric symptoms, such as anxiety, are often the first indicators of hypothyroidism (Hall & Lowrance, 2002, & 2006).  Anxiety disorders occur in approximately 30-40% of patients with emerging acute hypothyroidism (Hall, 2002).  Severe anxiety attacks, panic attacks, and “free floating anxiety”, or a continuous feeling of being on edge, are all common anxiety reactions when hypothyroidism is developing (Lowrance, 2006). 

Hall (2002) reports the rapidly changing hormone levels in hypothyroidism is a key factor in the development of anxiety symptoms.  Patients with myxedema, a condition caused by hypothyroidism which involves blunting of the intellect and senses, thickening skin, and labored speech, present with progressive anxiety accompanied with generalized anxiety (2002).  Delusions, hallucinations, paranoia, and extreme restlessness mixed with lethargy are all common in individuals with myxedema.  Patients with more gradual drops in hormone levels still present with anxiety symptoms, but normally have a type of “chronic anxiety”. 

Lowrance (2006) reports in Hashimoto’s Disease that anxiety symptoms can be attributed not only to the abnormal thyroid levels, but also to the autoimmune disease process.  Anti-thyroid-peroxidase and anti-thyoglobulin, two anti-thyroid antibodies, can cause depression and anxiety symptoms even before hormone levels are out of the normal range (2006).  Lowrance states, “Researchers describe the anxiety symptoms from autoimmune hypothyroidism, as being caused by the gland’s attempts to ‘sputter back to life’ as it begins to fail and in attempt to fight off the autoimmune attack.  The actual medical term for this is ‘Hashitoxicosis’ and patients will have it to varying degrees but usually…causes significant anxiety symptoms.” 

When psychiatric clinicians are initially analyzing a patient, medical conditions must be considered before a diagnosis is made.  Some subtle differences may alert a clinician of the differences between psychologically caused and medically caused anxiety disorders.  For instance, medically induced anxiety disorders often show instability in the duration and severity of panic attacks or anxiety (Hall, 2002).  In addition, patients with anxiety disorders that form prior to the age of eighteen or after the age of 25 and who have a negative personal and family history of anxiety should be closely analyzed for an underlying medical condition (2002).  Hall reports that anywhere from 10-40% of medical patients with anxiety disorders are thought to have an organic etiology for their symptoms. 

The importance of taking medical conditions into consideration when diagnosing psychiatric patients is great.  If the anxiety disorder is truly organically induced, a patient will not recover psychologically without treatment of the physical disorder. Because emotional symptoms often arise before any physical symptoms in hypothyroidism, both patients and clinicians often make the mistake of attributing the disorder to a mental health problem.  While psychiatric drugs alone cannot cure the psychological symptoms involved during hypothyroidism and may in fact make the situation worse, drugs that treat the hypothyroidism will normally cure the anxiety symptoms, as well as the medical condition.  Lowrance (2006) exclaims, “Remember, thyroid diseases are a major cause and possibly the most common ‘medical cause’ of emotional symptoms!”

The articles presented by EndocrineWeb.com (2005), Hall (2002), and Lowrance (2006) provide both solid explanations and examples for anxiety symptoms presented in hypothyroidism.  Though the exact medical etiology is debatable and may involve a combination of factors, the high correlation of anxiety symptoms in patients with hypothyroidism supports the organic basis of psychological symptoms. Some symptoms of anxiety may be brought upon by the stress of having the disorder; but considering anxiety symptoms often precede any physical symptoms, this seems unlikely to be the sole cause.   

References:

EndocrineWeb.com. (2005). Hypothyroidism. Retrieved October 17, 2006 from http://www.endocrineweb.com/hypo1.html

Hall, Richard. (2002). Anxiety and Endocrine Disease. Retrieved October 17, 2006 from http://www.drrichardhall.com/anxiety.htm

Lowrance, Jan & Jim. (2006). Anxiety and Depression Symptoms in Thyroid Disease.  BellaOnline.  Retrieved October 17, 2006 from http://www.bellaonline.com/articles/art41515.asp

Aspects of Latino Distinctiveness

The language barrier between natural born Americans and the typical Latino population is formidable. America values the English language, and many Latino immigrants know Spanish as their primary, or only, language. An unknown author said, “If you can speak three languages you’re trilingual. If you can speak two languages you’re bilingual. If you can speak only one language you’re an American” (Guillemets, 2006). Unfortunately, the dominant culture holds English as the “best” language and often treats other dialects as inferior. First, even though some Latinos are very light-skinned and could hide their ethnicity in presentation by passing; if their accent is strong or English is weak, they will reveal their cultural identity regardless if attempting to or not. Second, many American businesses do not have bilingual representatives, which causes great difficulty for Latino customers. Another problem is few school systems have teachers that are fluent in both English and Spanish. If a child is raised to speak Spanish at home and in the community, but then expected to learn English quickly, especially through indirect means, the assimilation can prove very challenging. Most students are required to test in English, regardless of the subject. For children unable to have a full understanding of the English language, many will fail regardless of how intelligent they may be. These children are often put in the special education programs (Sue and Sue, 2003) which will hamper their educational growth because the problem is not intelligence, it is the language barrier. English has often been called one of the most difficult languages to master. Gustav White says, “Our language is funny – a fat chance and slim chance are the same thing” (Guillemets, 2006).

Some aspects of the Latino population’s language can actually supply a form of resilience for the group. For instance, many employers are looking for Spanish speaking individuals. The Hispanic population now comprises the largest minority group in America; five years ago there were thirty-six million counted Latinos. (Sue and Sue, 2003). If someone is bilingual, their chance of getting a job greatly increases (Hollister, 2002). Also, Spanish speaking individuals have a common bond with other Spanish speaking Latinos. This bond and familiar language helps keep a piece of their culture alive, the parts that “are worth keeping” (Espin, 2006). Some Latinos do this by deliberately flaming or, in this case, talking in Spanish so outside individuals will know what group they are part of (Rosenblum & Travis, 2006).

Providing counseling to the Latino population, especially older or recent immigrants, can prove very difficult. For one, the meaning of words is extremely important in the counseling process. The only way a psychological service can be helpful is if the two individuals, the counselor and the client, are able to successfully communicate through written or spoken words. Even during the initial intake, a bilingual individual could score differently on the English and Spanish exam (Sue and Sue, 2003). During translation, whether by an interpreter or the client whose primary language is not English, wording and sentence structure is often misconstrued as meaning something entirely unlike what is said (2003). Many words and phrases, though interpretable, have a special meaning for different countries and groups of people. I found a quote by Antonio Prochia, which was translated from Spanish, to sum up the differences in word interpretation: “What words say does not last. The words last. Because words are always the same, and what they say is never the same” (Guillemets, 2006).

References:

Gonsiorek, J. (2006). Interview with Dr. Oliva Espin: Latino/Latina Communities. Retrieved July 30, 2006 from Capella University.

Guillemets, Terry. (2006). The Quote Garden. Retrieved August 2, 2006 from http://www.quotegarden.com/language.html.

Hollister, Julia. (2002). A Way with Words: Bilingual applicants enjoy a pronounced advantage in the job market. California Job Journal. Retrieved August 2, 2006 from http://www.jobjournal.com/article_printer.asp?artid=654.

Rosenblum, K. E., & Travis, T. M. (2006). The meaning of difference: American constructions of race, sex and gender, social class, and sexual orientation (4th Ed.) New York: McGraw-Hill.

Sue, D.W. & Sue, D. (2003). Counseling the Culturally Diverse Theory and Practice (4th Ed.). NY: John Wiley & Sons, Inc.

Mexican American immigrants vs. Non-Latino immigrants

“Much of what we now consider to be problems concerning immigration and assimilation really concern Mexican immigration and assimilation” (Huntingdon, 2000). Contiguity is one of the biggest factors in this. Unlike other immigrants, Mexicans can easily cross the border without high costs and extreme risk. In the same regard, they can return home just as easily to visit with friends and family (2000). Much of Mexican migration is viewed as temporary: “A low-skilled, low-educated migration widely thought to locate in the U.S. only temporarily understandably retards assimilation” (Fonte, Carens, and Krikorian, 2000). Much of this has to do with illegality.

Illegality is another substantial difference from other immigrant groups. Sue and Sue (2003) estimate there to be seven million illegal Mexican immigrants who, consequently, are part of the bottom rung of the labor pool and rarely see doctors. Nine years ago, it was estimated that Mexican immigrants accounted for 54% of all illegal aliens- nine times greater than the next largest group. The Border Patrol stops over one million individuals crossing the Mexican border illegally every year (Huntingdon, 2000).

Also, the concentration of Mexican immigrants is much greater in the Southwest, mostly in Southern California. One writer said, “No school system in a major U.S. city has ever experienced such a large influx of students from a single foreign country. The schools of Los Angeles are becoming Mexican” (Huntingdon, 2000). Other immigrant groups have a diverse migration spreading over New Jersey, New York, Florida, Illinois, etc. (Fonte, Carens, and Krikorian, 2000).

One similarity is consistent among immigrant groups. Manuel Garcia y Griego declares Mexican immigrants are comparable to European immigrants in “their motivation for migration and in their aspirations for life in the United Status” (Fonte, Carens, and Krikorian, 2000). I believe 99% of immigrants have a similar goal in mind: To live the “American dream”. Unfortunately this dream, especially for Mexican immigrants, can turn into more of a nightmare when poverty, health concerns, and racism all play a part in the life of an immigrant.

References:

Camarota, Steven A. (2001). Immigration from Mexico: Assessing the Impact of the United States. Center for Immigration Studies. Retrieved August 5, 2006 from http://www.cis.org/articles/2001/mexico.toc.html

Fonte, John, Carens, Joseph, and Krikorian, Mark. (2000). Are Mexicans a Special Case? Cantigny Conference Series, Wheaton, IL. Center for Immigration Studies. Retrieved August 5, 2006 from http://www.cis.org/articles/cantigny/proceedings.html#III

Huntington, Samuel (2000). Reconsidering Immigration: Is Mexico a Special Case?. Center for Immigration Studies. Retrieved August 5, 2006 from http://www.cis.org/artickles/2000/back1100.html

Kaiser Family Foundation. (2005). Mexican Immigrants’ Health Status Worsens After Living in U.S., Study Finds. Daily Health Policy Report. Retrieved August 5, 2006 from http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=3&DR_ID=33115

Sue, D.W. & Sue, D. (2003). Counseling the Culturally Diverse Theory and Practice (4th Ed.). NY: John Wiley & Sons, Inc.

Mexican American immigrants vs. U.S. born Mexican Americans

 

While native born or second and third generation Mexican immigrants seem to fare far better than recent immigrants, they are still on the low-end of the totem pole in many respects. For instance, over two-thirds of recent Mexican immigrants and almost half of “long-term immigrants” do not have health insurance, while only a fifth of Mexican-born Americans are without (Kaiser Family Foundation, 2005). While it is encouraging that native Mexican Americans are almost twice as likely to have health insurance, they still have are half as likely to have insurance as Caucasians (2005).

As far as education goes, second and third generation Mexicans have a much greater success rate in completing high school than Mexican immigrants, but they still have a significantly increased drop-out rate compared to other natives (Camarota, 2006). Unfortunately, positive progress does not seem to be on the rise, and the number of Mexican college graduates is minimal. Second-generation Mexican Americans are about 4% less likely than immigrants to use welfare, but the comparison of third generation and native Mexicans is very similar; and once again, the progress being made is nominal (2006). A researcher stated, “Differences in skills and labor market outcomes may persist across generations and need never converge” (2006). One significant similarity between native born Mexicans and immigrants is their values and political philosophies. Positions on abortion and even immigration controls are similar and Garcia y Griego states, “Mexican-Americans, in some significant ways, mirror the native-born population (Fonte, Carens, and Krikorian, 2000).
References:

Camarota, Steven A. (2001). Immigration from Mexico: Assessing the Impact of the United States. Center for Immigration Studies. Retrieved August 5, 2006 from http://www.cis.org/articles/2001/mexico.toc.html

Fonte, John, Carens, Joseph, and Krikorian, Mark. (2000). Are Mexicans a Special Case? Cantigny Conference Series, Wheaton, IL. Center for Immigration Studies. Retrieved August 5, 2006 from http://www.cis.org/articles/cantigny/proceedings.html#III

Huntington, Samuel (2000). Reconsidering Immigration: Is Mexico a Special Case?. Center for Immigration Studies. Retrieved August 5, 2006 from http://www.cis.org/artickles/2000/back1100.html

Kaiser Family Foundation. (2005). Mexican Immigrants’ Health Status Worsens After Living in U.S., Study Finds. Daily Health Policy Report. Retrieved August 5, 2006 from http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=3&DR_ID=33115

Sue, D.W. & Sue, D. (2003). Counseling the Culturally Diverse Theory and Practice (4th Ed.). NY: John Wiley & Sons, Inc.

Difficulties faced by Mexican American Immigrants

Mexican Immigrants, who compose two-thirds of Hispanic immigrants (Huntingdon, 2000), face many challenges while living in the United States. Two-thirds have not finished high school, accounting for 22% of all high school dropouts in the work force (CIS, 2001). Along with this low education come low wages, poverty, and welfare. Mexican immigrants account for one out of ten individuals in poverty and one out of twelve without insurance. Thirty-four percent of Mexican immigrant households with a legal alien head are on welfare, along with twenty-five percent of households with an illegal alien head (2001). Unfortunately, even Mexican immigrants living here for more than twenty years share like statistics.

Most immigrants come to this country healthier than Americans, but this soon changes on arrival. Around seven percent of Mexican immigrants living in the United States less than ten years have fair or poor health (Kaiser Family Foundation, 2006). After living in the United States for more than fifteen years, this figure increases to fifteen percent. “It is unknown…if worsening health status is a result of years of difficult labor and poverty, changing health behaviors like diet and smoking or insufficient preventive medical care” (2006). Poor physical health brings about poor mental health in many cases, increasing the need of multicultural psychologists.

In addition, even though wage statistics are grim, many unskilled American workers feel threatened by Mexican laborers. Over ten million native born Americans without a high school diploma face noteworthy job competition from Mexican immigrants and this competition reduces wages for individuals without a degree by five percent (CIS, 2001). Fierce job competition brings about opposition by American workers. This opposition may often lead to hate crimes and job sabotaging.

Poverty, lack of education, health decline, and racism; along with other factors not mentioned, such as language barriers, sex role expectations, and differing values, are only a few of the conflicts Mexican Americans run into during the assimilation process. This process can leave Mexican immigrants depressed, scared, angry, lonely, and confused. Many immigrants probably wonder if they should have come after all. When combining the psychological problems with therapy challenges and a reluctance of seeking help, it only makes sense that immigrants have a higher percentage of mental tribulations (Sue and Sue, 2003).
 References:

Camarota, Steven A. (2001). Immigration from Mexico: Assessing the Impact of the United States. Center for Immigration Studies. Retrieved August 5, 2006 from http://www.cis.org/articles/2001/mexico.toc.html

Fonte, John, Carens, Joseph, and Krikorian, Mark. (2000). Are Mexicans a Special Case? Cantigny Conference Series, Wheaton, IL. Center for Immigration Studies. Retrieved August 5, 2006 from http://www.cis.org/articles/cantigny/proceedings.html#III

Huntington, Samuel (2000). Reconsidering Immigration: Is Mexico a Special Case?. Center for Immigration Studies. Retrieved August 5, 2006 from http://www.cis.org/artickles/2000/back1100.html

Kaiser Family Foundation. (2005). Mexican Immigrants’ Health Status Worsens After Living in U.S., Study Finds. Daily Health Policy Report. Retrieved August 5, 2006 from http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=3&DR_ID=33115

Sue, D.W. & Sue, D. (2003). Counseling the Culturally Diverse Theory and Practice (4th Ed.). NY: John Wiley & Sons, Inc.

Filipino Americans: Family vs. Individual

Filipino Americans, the second largest Asian group in America, hold family as a high priority in their daily lives (McBride, n.d.); therefore, one cultural feature is that of strong interdependence and togetherness. Traditional Filipino families consider the family elders to be of great importance, and the younger members are taught that caring for the elders is their responsibility (McBride). “It is always relational, hierarchical, and given this group of communal culture, the word ‘independence’ really makes little sense. Interdependence is more of the optimal cultural expectation and value”. Though every culture is different, the emphasis is on the family in the majority of Asian cultures (Gonsiorek, 2006).

“Many contemporary Filipino American families continue to function in a complex process of a natural support system of reciprocity within interdependent/dependent relationships based on extended family membership, group harmony and loyalty, respect for elders and authority, and kinship that goes beyond strong biological connections” (McBride). Because of the strong family ties most traditional Filipino families hold, counseling in the Western world can be very difficult and unsuccessful. To begin with, counseling in the United States focuses greatly on independence and individualism; whereas most Asian cultures, including the Filipinos, have a group and family orientation (Sue and Sue, 2003). To make things even more difficult, one must determine the depth of assimilation, family experiences, etc. before making an assumption this is true. Even a family that has been in the United States for many generations may have passed on their traditional Filipino values from generation to generation (McBride).

Often, not only is family of more importance in Filipino culture, but also the structure is very different. Many families are multigenerational and members of the family are responsible for making decisions for the elders, as well doing everything in their power to fix the problem before seeking formal medical care (McBride). There is a general wariness in the Filipino culture towards “external forces” and adult members in the household may impede professional treatment because they are trying to protect their elders. When Filipinos choose to immigrant at an older age, they often do not speak English well and are unable to easily adapt to modern technology. Adult children are expected to fulfill these roles for the elder (McBride). A counselor can not automatically assume these things to be true of a Filipino individual though, because elders very acculturated to US customs may make their own appointments. This alone is one of the difficulties of multicultural counseling- trying to determine if an individual’s values are similar to the dominant culture or towards their group’s traditional culture.

When counseling Filipino families, I would have to ensure I respected the hierarchy of the family. I would need to greet the oldest family member first. Most often individuals are designated as the decision makers for an elder, or the family makes a decision as a whole. I would need to ask questions such as, “Who should I talk to who can help with making decisions about your treatment in the future?” (McBride); rather than putting the responsibility of treatment on the client in need.

Also, addressing a Filipino member by their first name may be viewed as derogatory, especially if the age difference is much greater for the Filipino (McBride). Talking about my own children or family could put the Filipinos at ease. Asking the younger member if an elder needed an interpreter or automatically providing one could be viewed an as insult. Many Filipino elders are very proud of their ability to speak English. In addition, keeping eye contact, using discretion involving touch, and using a firm handshake are all additional ways to form a good relationship with the Filipino client (McBride).

There are many ways in which the traditional Filipino culture differs from Western culture. Counselors must be aware of these potential differences. Though difficult, this is the only way to keep the client coming back. One the most important things to remember and focus on is the family structure. Learning to counsel an entire family opposed to an individual can be challenging, but Western counselors must learn to respect the core Filipino value kapwa, or “shared identity, interacting on an equal basis with a fellow human being” (McBride).

Gonsiorek, John. (2006). Interview with Dr. Gock. Asian Pacific Communities. Retrieved on August 6, 2006, from http://courseroom.capella.edu

McBride, Melen. (n.d.). Health and Health Care of Filipino American Elders. Standford Geriatric Education Center. Stanford University School of Medicine. Retrieved August 5, 2006 from http:// www.stanford.edu/group/ethnoger/filipino.html

Sue, D.W. & Sue, D. (2003). Counseling the Culturally Diverse Theory and Practice (4th Ed.). NY: John Wiley & Sons, Inc.

Zen Shiatsu

Shiatsu was originally an oriental treatment used as a preventive health care method by the Chinese. In ancient China, doctors only charged for the preventive health measures; once someone was sick, the treatment was free (Visser, n.d.). Now the Japanese have adapted Shiatsu to fit their culture, and Zen Shiatsu is one of six different styles (Prescott, 2006). The easiest way to describe Zen Shiatsu is “massage therapy”, but it is much different than the every day American massage.

Shiatsu is used to heal a variety of problems ranging from the physical to the mental to preventive care. It serves as a diagnostic and therapy tool in one. Shiatsu was recognized by the Japanese government around the 1960s as an official medical procedure (Dharmananda, 2002). Zen Shiatsu was actually created by a psychology professor at Toyko University, Shizuto Masunaga, who was brought up in a family of Shiatsu practitioners. This special branch of Shiatsu incorporates Zen, which is one of the sects of Buddhism involving exercising the mind through meditation (Dharmananda).

Zen Shiatsu focuses on chi and meridians. Chi in the Asian culture is known as “the power to live”, and a lack of chi is the reason for sickness or even death. Twelve meridians, or the channels of chi, flow through the body and correspond with specific organs (Visser, n.d.). The therapist searches for ‘kyo’, or meridians with too much energy [chi], and ‘jitsu’, or meridians with the least chi. Since the ultimate goal is to achieve a state of balance, which is looked upon highly in Asian culture, both the kyo and the jitsu have to be worked out (Prescott, 2006). Where Western psychologists normally utilize a “diagnose and then treat” methodology, a Zen Shiatsu therapist diagnoses and treats many times throughout a session. In addition, rather than looking for a disease with certain symptoms, the goal is to reach a state of balance, as mentioned above (Prescott).

To help the client reach the aforementioned state of balance, the therapist must be in a relaxed meditative state. The practitioner must be skilled at detecting the source of problems, and the body’s responses to treatment (Prescott). Clients ideally lay on a mat on the floor and wear light clothing. Therapists do not use oils or lotions because rather than sliding up and down or in a circular motion, pressure is applied to the entire body on the meridians (Dharmananda, 2002). Abdominal palpation is the primary diagnosis method to determine whether meridians are kyo or jitsu. After the initial diagnosis, intense pressure is applied to the meridians by the hands, elbows, or other parts of the practitioner’s body. Moving the client is common in order to gain better access to certain meridians or to apply enough pressure to certain areas (Dharmananda). The entire process is then repeated until the meridians seem to be in balance.

This technique is supposed to “jump-start” the body’s natural healing powers by calming the autonomic nervous system. Also, Zen Shiatsu improves circulation which, in turn, fortifies muscle tone and organ functioning. Some even believe it strengthens the immune system. Whether one has neck pain, insomnia, fatigue, etc., the treatment in Japan is Zen Shiatsu (Dharmananda, 2002).

Many Americans use massage therapy or chiropractors for stress or physical pain relief. While Zen Shiatsu is a much deeper form of therapy and the results are deemed to be very different, the physical aspect of the treatment is somewhat similar. There are several schools in the United States that teach Shiatsu. Some counselors are now recommending like methods of alternative medicine, such as acupuncture. Even though the majority of Western counselors may not believe in all the benefits of Shiatsu, this form of therapy is not as abnormal [in terms of western values] as some.

References:

Dharmananda, Subhuti. (2002). Zen Shiatsu: The Legacy of Shizuto Masunaga. Institute for Traditional Medicine. Retrieved August 9, 2006 from http://www.itmonline.org/arts/shiatsu.htm

Prescott, Rebecca. (2006). Zen Shiatsu and The Art of Healing. Retrieved August 9, 2006 from http://www.buzzle.com/editorials/3-21-2006-91551.asp

Visser, Rian. (n.d.). Shiatsu: Japanese massage. Retrieved August 9, 2006 from http://www.rianvisser.nl/shiatsu/e_watis.htm

Diabetes Prevention Strategy

It is estimated that only ten percent of the original Native American population was alive by the eighteenth century (Sue and Sue, 2003). Much of this was due to disease. After being placed on reservations, the rate of obesity and diabetes rose drastically due to their sedentary lifestyle (Sue and Sue). A counselor can help an individual combat the physical aspects that lead to obesity and diabetes by establishing an informative and positive counseling method with the client. The outline Sue and Sue created for drug and alcohol counseling can be modified to create a successful diabetes prevention strategy.

To begin with, the first step in preventing diabetes is through knowledge. After finding out more information from my client, I would inform my clients what effects non-activity, unhealthy eating, and heavy alcohol use can have on the body. I could provide my clients with free literature from The Diabetes Association, or suggest other reference materials. I would also make my clients aware of the complications of diabetes, such as loss of eyesight, heart disease, or even kidney failure.

After making my clients aware of the causes and dangers of diabetes, I might refer my clients to a dietician if necessary. The clients would then be able to learn what to eat and what not to eat, as well as how much exercise is needed. The dietician could provide healthy tips such as choosing how to say “no” to certain foods, and how to determine how to eat balanced meals. If one is not aware of what foods are healthy and how blood sugar is controlled, he or she will not have the knowledge to make smart food choices.

Changing diet is not easy. I, myself, take a diabetic medication called metformin. Though offering personal opinions and thoughts is often frowned against in the mental health profession, I could share some of the ways I coped with changing my diet. Small tips such as avoiding the candy aisle and finding alternative solutions to unhealthy foods could help the client realize eating a healthy diet can still be enjoyable.

I believe one of the best ways of enforcing diabetes prevention, especially in native populations or other family-centered cultures, would be to bring the whole family into the counseling process. If the entire family is educated, each member can use positive reinforcement (Sue and Sue) to encourage one another. It is much easier for one to stick to a diet plan, or even for a smoker to quit, if the people around that person support him or her.

Making diabetes prevention one aspect of family “togetherness” could be looked on favorably by family-centered individuals. Along with diet, the family could schedule a time each week (or each day, as time permits) to do some kind of physical activity together. A counselor could present this strategy as a time to bond, while strengthening the body and soul.

For clients with a more individual identity, encouraging the buddy system could be productive. Some favorable suggestions would be to join a support group, utilize a health club, or become a member of a sports team. Any kind of positive support is healthy.

Most of all, I would try to emphasize a healthy lifestyle is doable and preventing diabetes is much easier than trying to manage diabetes itself. Providing resources, helping the client or family to set goals, and encouraging a positive social network would be strategies I would employ in a diabetic prevention program.

Sue, D.W. & Sue, D. (2003). Counseling the Culturally Diverse Theory and Practice (4th Ed.). NY: John Wiley & Sons, Inc.

Multiracial Identity: African-Native Americans

Rosenblum and Travis (2006) state, “In day-to-day living, however, race is often used as a clear-cut unambiguous way of categorizing human beings. Those of us who do not come from or live in single-race families must daily negotiate a racialized and racist system that demands we fit ourselves into prescribed categories”. It is difficult enough to be part of a stigmatized race in the United States. Add two stigmatized races together and the difficulty only increases. Being a biracial individual of African American and Native American (A.N.A. will be used for short) genetics poses challenges with the dominant culture, as well as individuals of his or her own heritage.

As mentioned above, both African Americans and Native Americans are stigmatized groups with a great history of struggle. An A.N.A. might feel pain from the history of slavery, as well as the government’s betrayal. Either way, this individual may have issues with trusting an individual of the White, dominant culture. “…American Indians [are] very suspicious of the motives of the majority culture, and most of them do not expect to be treated fairly” (Sue and Sue, 2003). The same is true for many African Americans.

For the first time in census history, an individual was able to mark more than one race on the 2000 survey (Rosenblum and Travis, 2006). Even so, there was no category entitled “multi-racial” and our society continues to expect an individual to “name a race”. Stating an answer of “biracial” when questioned about one’s race is not enough. An A.N.A. individual could face an internal battle about his or her race. To begin with, the “one-drop rule” would classify an A.N.A. as black; yet in most tribes or states, a Native American is classified as one who has at least half or a quarter of Native American blood. In Virginia, the answer is an A.N.A. who is at least one-fourth Native American and less than one-sixteenth African American is deemed Indian while on the reservation and black otherwise (2006). Dealing with this classification system can be very damaging for adolescents or adults. An A.N.A. who grew up in a reservation may have been classified as Native American his or her entire life; and then on departure, he or she is expected to consider himself or herself African American.

Often, multiracial individuals tend to claim one race because, “People of mixed heritage are often ignored, neglected, and considered nonexistent in our educational materials, media portrayals, and psychological literature” (Sue and Sue, 2003). Many biracial children feel guilty when only identifying one race because they love and respect both parents. Other children may suffer from being raised as monoracial in the household, but viewed as biracial (or of the other race) from outsiders. In addition, children often feel little support from their parents because the parents can not understand the difficulties their children face (2003).

Also, the majority is not the only group to deem multiracial individuals as inferior; this concept especially hold true for the Native American population. “There is…[a] principle about which the whites and the Indians are in agreement….People with more Indian blood…also have more rights to inherit what their ancestors, the former Indians, have left behind. In addition, full blood Indians are more authentic than half-breeds. By being pure, they have more right to respect. They are in all aspects of their being, more integral” (Rosenblum and Travis, 2006).

Many Native Americans are unaccepting of individuals who do not look the part. Being too light or too dark is often a factor for discrimination in the Indian population. One individual states “As Indian people, we do want to have Indian people that look like they’re Indian to represent us”. One Hopi respondent said an individual who was too dark (or too light) could not participate in certain ceremonies (2006). The feeling of many Native Americans is presented by Rosenblum and Travis in this quote: “Us Indians, whenever we see someone else who is saying that they’re Indian…or trying to be around us Indians, and act like us, and they don’t look like they’re Indian and we know that they’re not as much Indian as we are…”

Being black, of Indian descent, or even multiracial brings up many stereotypical images. First, both groups have been characterized as “childlike and savagely brutal” (Rosenblum and Travis, 2006). Rates of unemployment, educational difficulties, and out of wedlock births are much higher than the national average for blacks and Indians. Both groups have been viewed as inferior throughout history, and many whites view individuals of these minorities as requesting handouts and using affirmative action campaigns in a negative manner. Multiracial individuals are viewed as half-breeds and “‘Half-breeds’ by this logic could be expected to behave in ‘half-civilized,’ ie., partially assimilated, ways while retaining one half of their traditional culture, accounting for their marginal status in both societies” (2006).

As detailed above, African American or Native American must deal with the horrors of their group’s past, being part of a stigmatized group, and having less opportunity than their white counterparts. Being a member of both races only adds to the internal and external turmoil. Trying to decide whether to claim one race or two, and if one- which race to pick; as well as being viewed as “less human” by both the majority and minority groups can be disheartening. “Proponents have argued that it is unfair to force one identity on multiracial people, that it creates alienation and identity confusions, that it denies racial realities, that there should be pride in being multiracial…Custom, history and prejudices, however, continue to affect perceptions regarding a singular racial identity” (Sue and Sue, 2003).

References:

Rosenblum, K. E., & Travis, T. M. (2006). The meaning of difference: American constructions of race, sex and gender, social class, and sexual orientation (4th Ed.) New York: McGraw-Hill.

Sue, D.W. & Sue, D. (2003). Counseling the Culturally Diverse Theory and Practice (4th Ed.). NY: John Wiley & Sons, Inc.

Guidelines for Counseling the Elderly

Psychological Guidelines to be followed by all therapists when counseling the elderly:

1. Do not assume the individual is mentally incompetent because of his or her age.

2. Do not look at the individual as a “stereotypical grandmother or grandfather”.

To begin with, many individuals assume an elder to be of “lesser mind” or senile. Though memory may decline somewhat with age, individuals with dementia are in the minority rather than the majority (Sue and Sue, 2003). Elderly individuals are often the best teachers because their life experiences and knowledge succeeds younger individuals. Automatically assuming a client is mentally slower or weak-minded will not only offend a client, but also keep a rapport from being established. Without a rapport, therapy will likely be useless.

Secondly, expecting an elderly client to follow the “typical” role of grandmother or grandmother is not only naïve, it is downright ludicrous. Not all elderly people go to bed at eight or have strict morals. They are individuals formed by their individual experiences. Take, for example, a past neighbor I had. The woman was in her 70s, but rarely stayed in her apartment. She most often stayed across the street with an elderly man. I will admit I was a bit shocked at first when seeing two elderly, unmarried individuals “shacking up”. My mother always told me, “Just because you get older doesn’t mean your desires change.” A therapist must keep an open mind when counseling the elderly. Sexual desire and drug and alcohol addiction is not isolated to those of a young age (Sue and Sue, 2003).

The study of elder status in the Filipino culture has many aspects that can be integrated into service guidelines for all elders. One problem Filipino elders often experience is elder abuse. “Among intergenerational Filipino households, some elders’ access to screening services may be facilitated, delayed, or rejected by adult family members who feel an obligation to protect their elders from external forces” (McBride, n.d.). In addition, family members are often uninformed of resource availability and feel caring for family members is their responsibility. While this abuse may be indirect, some elders may need professional care and have no access to it. Filipino elders often seek professional help when all other options have been exhausted and their situation is dire (McBride). “Over 2 million older Americans are victims of psychological or physical abuse and neglect” (Sue and Sue, 2003). Counselors should watch for signs of elder neglect by asking questions about housing stability, medical health, etc.

Another thing to look for in Filipino elders is situational depression. Negative stigmatism, limited financial resources, and other factors associated with immigration may cause Filipino elders situational depression. On the same note, stigmatism, financial difficulties, and health problems are more prevalent in the elderly society as a whole (Sue and Sue, 2003). All of these factors contribute to depression caused by trying circumstances. Considering even members of the dominant society, particularly white males over 85, are six times as likely to commit suicide as the general population (Sue and Sue), depression and suicidality assessment should be of the utmost importance for the majority and minority alike.

There are certain general guidelines to be followed when counseling Filipino elders. To begin with, using the terms Miss, Mr., or Mrs. will show respect, while addressing a Filipino elder by their first name will do the opposite (McBride). Another guideline that is important is to address the elder first (if with family members), while using eye contact, smiling, and a giving a firm handshake. Also, sharing stories about your own family or making small talk will often put a Filipino elder at ease (McBride). I believe all of these techniques could be easily and successfully incorporated into an elder’s therapy program. The old saying “always show respect to your elders” is a good one to remember, especially when the age gap is substantial.

Counseling elders can be a learning process, but with an open mind, a very enjoyable one. The avoidance of stereotyping elders as senile and the “grandmother or grandfather” type is essential. Learning from the Filipino culture and integrating some core concepts pertaining to their elder therapy can be helpful. Also, checking for things such as elder abuse and situational depression are imperative.

References:

McBride, Melen. (n.d.). Health and Health Care of Filipino American Elders. Standford Geriatric Education Center. Stanford University School of Medicine. Retrieved August 5, 2006 from http:// www.stanford.edu/group/ethnoger/filipino.html
.
Sue, D.W. & Sue, D. (2003). Counseling the Culturally Diverse Theory and Practice (4th Ed.). NY: John Wiley & Sons, Inc.

Discussion: African American Struggles Continue

All the aforementioned statistics are presented to stress how formidable the hurdles African Americans face really are. “Given these disparities in wealth, it comes as little surprise why whites do better than others, and particularly better than blacks, on almost every measure, and that they do so over generations” (Squires, 2006). Whether studying psychology or not, one should be able to see how these factors can have a large impact on the black individual, and their outlook on race. Children go through many stages in the developmental process, and African Americans are more likely to explore their racial identity. The world thinks of them in terms of race, so they too have to consider themselves in this manner (Rosenblum & Travis, 2006).  Some black children start off by following the white dominant culture because it is viewed as “better”, but once racial discrimination is inflicted on them, an opposition to white culture can occur.  Some teens refuse to engage in any act that could be perceived as a “white activity”.  Growing up, I always wondered why black individuals had such a close bond with each other and how something as simple as color can bring people together so much.  Even as I grow older and have become intertwined into the black culture, I still realize no matter how close I am to some individuals; the black bond they share is something special that I have no part in. I believe I now have a better understanding of the concept though; it is not about skin color, it is about a common struggle. While researching for the last post, I read some excerpts to my partner out of the text, and discussed my thoughts on the matter at hand.  The subject of race has come up countless times in our five years of being together, but I noticed a bit of discomfort on his part. When I asked what was wrong, he simply stated, “I am living it”. I then realized regardless of the research I do, or how assimilated I may be, I will never know what it feels like to be discriminated against in such a manner.  Sure, I know how discrimination feels.  I would dare to say everyone has experienced bias in some sort or fashion, but blacks in the
United States experience a more extreme form than most other Americans.   

African Americans have a strike against them from birth, even if it is not apparent to them until they get older.  Though progress has been made in the last century, the statistics presented are not very pleasant. There are many thriving blacks, but the road to success is not always an easy one.  Some lose their black friends because their values may be viewed as part of the white society.  Others face tremendous difficulties because of racial profiling.  We, as a human race, must become aware of the trials our fellow men and women face every day: “Recognizing the continuing black/white divide is a vital next step in the struggle for racial justice in the
United States” (Squires, 2006). 

You can download/open the entire document African American Struggles. 

It contains the references I used and is in Microsoft Word format.

Black Crime and Incarceration

The chance of an African American male going to prison is almost 30% higher than a white man (Frazier, 2005).  While most view this statistic as “blacks commit more crimes”, one should see how skin color alone increases the percentage of arrests for blacks.  For one, the average jail sentence, for the same crime, is 6 months longer for blacks than whites (Frazier).  How is that considered justice?  This only tells white individuals they can get away with much greater crimes and do less time, because they are privileged.  Rosenblum & Travis (2006) speak on how black parents have to instruct their children on how to deal with getting pulled over, because it is inevitable due to their skin color.    

You can download/open the entire document African American Struggles. 

It contains the references I used and is in Microsoft Word format. 

Employment Barriers for African Americans

If you were interviewing two people with equal skills, one with a felony record and one without, who would you pick?  Well, research shows employers are more likely to pick the individual with a felony record if he or she is white and the other applicant is black. Also, individuals with “white sounding” names are more likely to get a job than those with “African American names” (Squires, 2006). These study results, along with the statistics on education and housing, may very well account for the 50% unemployment rate for black men in New York City and the double-digit average for all other black men over the age of twenty (Frazier, 2005). 

Not only do blacks have a harder time getting jobs, they tend to make less than whites.  As of 2002, the median household net worth for Caucasians was $88,651, and a mere $5,988 for blacks.  Latinos even had a $2,000 net income above blacks (Squires, 2006). In 2000, black males earned 64 cents to the dollar, only up 14 cents from 1960 (Texeira, 2006).  In addition, the mean earning in 2003 of black males with a professional degree compared to white males with the same degree was $37,264 less (Vital Statistics, 2006).

You can download/open the entire document African American Struggles. 

It contains the references I used and is in Microsoft Word format.

Black Housing Discrimination

Some people would probably ask why, if black schools are so bad, people of color don’t just get up and move to a more diverse, integrated community.  Regrettably, this is much more difficult than it sounds.  Rosenblum and Travis (2006) state, “blacks remain the most spatially isolated population in
U.S. history”, because over 30% of African Americans live in neighborhoods that are 90% black. It has been found that regardless if the black individuals moving into a neighborhood have equal or greater wealth than their white counterparts and crime does not go up, whites will still move away because they think the more blacks moving in, the “worse” the neighborhood will be (Rosenblum & Travis). In one survey, 20% of whites, 33% of Hispanics, and 40% of Asians said they would rather live in a neighborhood without any blacks. “Blacks are the least favored neighbor by all other racial and ethnic groups” (Squires, 2006). Historically, one facet of segregation has been to bar black individuals from purchasing homes in certain areas (Texeira, 2006).   Even if this were not the case, some blacks do not want to feel discriminated against and choose to stay in a black neighborhood (Rosenblum & Travis). Also, while over 75% of whites own homes, the figure is less than half for African Americans.  Surprisingly, blacks are 60% more likely to be denied for a home loan than white counterparts even when credit scores are the same (Texeira, 2006).  The most current national housing inequity study revealed illegal discrimination was encountered in 20% of visits to a rental or real estate agent. Even phone calls are screened for the “recognizable black voice” (Squires, 2006). 

You can download/open the entire document African American Struggles. 

It contains the references I used and is in Microsoft Word format.

Inequality in Black School Systems

“White privilege is most explicitly demonstrated by inequalities in the distribution of wealth” (Squires, 2006).  This inequality is apparent to the black majority in all stages of life.  To begin with, school systems containing a high percentage of blacks are often poorly maintained, crowded, and unsafe.  For instance, a survey in 2002 showed African American students had a 29% chance of attending a school with trash on the floor, opposed to 18% for white students; a 10% chance of having graffiti on their walls, opposed to 3%; and a 12% chance of damaged ceilings, compared to 7%. Sadly, these results correspond to students who place the lowest on achievement tests (U.S., 2005). In an article entitled “Still Separate, Still Unequal:
America’s Educational Apartheid” (2005), Mr. Kozol speaks of an eight-year old girl from a school in the
Bronx that says, “We do not have the things you have.  You have clean things. We do not have. You have a clean bathroom. We do not have that. You have parks and we do not have Parks”.  At eight-years old, this child was very aware of the racial barriers already affecting blacks.  She knew what the “whites had” and what they [blacks] did not.   

The U.S. Department of Education reveals black tenth-graders were 24.4% more likely to attend schools with security guards, 18% with metal detectors, 9% with security cameras, and 7.6% with bars on the windows than white tenth-graders (Vital Statistics, 2006). Black schools- and more importantly- black children, are seen as more violent and needing greater security measures to control them.  As soon as I read these statistics I thought about the school massacres and was curious to how many were involving black teens. I found a wonderful, though blunt, article describing my outlook on the situation.  Tim Wise (2001) states,  

“White people live in an utter state of self-delusion. We think danger is black, brown and poor, and if we can just move far enough away from “those people” in the cities we’ll be safe. If we can just find an “all-American” town, life will be better, because “things like this just don’t happen here.” ….. What went wrong is that we allowed ourselves to be lulled into a false sense of security by media representations of crime and violence that portray both as the province of those who are anything but white like us. We ignore the warning signs, because in our minds the warning signs don’t live in our neighborhood, but across town, in that place where we lock our car doors on the rare occasion we have to drive there. That false sense of security — the result of racist and classist stereotypes — then gets people killed….A few years ago, U.S. News ran a story entitled: “A Shocking look at blacks and crime.” Yet never have they or any other news outlet discussed the “shocking” whiteness of these shoot-em-ups….Color-blind, I guess…..” 

Though black schools are more likely to have higher security measures, the minimum is provided in most other regards.  The per-pupil spending level for a child in New York City is half as much as in Manhasset,
Long Island (Kozol, 2005).  Also, the average salary for a teacher of the child Kozol aforementioned is $43,000, compared to $81,000 in Scarsdale which is only 11 miles away (Kozol).  How can race not play a factor when there is a mere 11 miles involved in a $38,000 teacher salary differential?  Many inner-city children do not even have the option of going to pre-school, but they are required to take the same tests (that decide whether they succeed or not) as the children that had the opportunity.  Unfortunately, many rich, well-educated individuals can not see past their own wealth and ask, “Is the answer really to throw money into these dysfunctional and failing schools?” (Kozol). Consequently, I would like to ask this question: how can these schools and the students within them ever have a chance when people constantly deny money and race as being an issue?

If it were not enough that black schools have less funds to utilize resulting in a poor school setting, these schools are rarely geared to promoting a future college education. In California at Freemont High School where the bathrooms are insufficient; many rooms are without air-conditioning; and the rats are abundant, the children are geared to a labor or “ghetto” mindset, as one of the children put it (Kozol, 2005).  Some of the classes available for the technical art requirements are “Life Skills”, “Sewing”, and “Hairdressing”- which one can take either braiding or hairstyling.  If a student attended Beverly Hills High school, he or she could take broadcast journalism, advanced computer graphics, or residential architecture, to just name a few.  Kozol writes about a situation involving a student at Freemont that wanted to take an AP class and had hopes of going to college.  One of her classmates exclaimed “Listen to me.  The owners of the sewing factories need laborers. Correct? It’s not going to be their own kids. Right? You’re ghetto, so we send you to the factory.  You’re ghetto—so you sew!”(Kozol). Nevertheless, many whites still hold onto the misperception that black prefer welfare and are incompetent (Rosenblum & Travis, 2006).  I would like to ask some of these individuals to consider this: Maybe they do not prefer it, but rather are persuaded into it?

 You can download/open the entire document African American Struggles. 

It contains the references I used and is in Microsoft Word format.

African American Barriers to Success

“Life expectancy, the quality and quantity of public education, the safety and security of neighborhoods, access to public accommodations, treatment by the criminal justice system, and almost every aspect of public and private life varies with race, with whites at the top, blacks at the bottom, and other minority groups somewhere in between on virtually every measure” (Squires, 2006). Though racism has became structurally invisible (Rosenblum & Travis, 2006), its effects are no less apparent; and “blacks remain the primary target” (Squires).  The increasing diversity and success of the American population has amplified the misconception that blacks are responsible for their [groups] problems relating to employment, education, housing, etc. (Squires).  Most people find it easier to blame this group than to accept the truth (Rosenblum & Travis). Unfortunately, the barriers this group faces are rooted both explicitly and inexplicitly in racial discrimination. Also, many of the mechanisms created to assist blacks with these barriers have been reallocated to other ethnic groups. Rather than taking a step forward in racial acceptance,
America has taken a step backwards in many regards- we just choose to pretend everything is now different. “Considerable effort is now being made to rid ourselves of this particular idea, to create what is sometimes a ‘colorblind’ society” (Michigan Today, 1996).  Children are not born with the realization they are black or white, or any race for that matter. It is society that soon embeds this train of thinking.  Though some adolescents may not think of themselves in terms of race (Rosenblum & Travis, 2006), studies have shown children have formed a negative viewpoint of individuals outside of their racial group by the age of three (Michigan Today, 1996). At three years old, a child should be worried about naptime; yet, society’s indirect racial stigmatisms are surprisingly apparent even to the young.  And what do almost all the barriers African Americans face center around? Wealth and power. 

 You can download/open the entire document African American Struggles. 

It contains the references I used and is in Microsoft Word format.

 

My One Month Metformin Anniversary

Oh happy day- today marks my one month anniversary on Metformin.  Two weeks ago I updated my dose to 850 2X a day and was puking my guts out and horribly sick for a few days.  After that, I started to slowly feel like normal again- and now I feel pretty good.  After going crazy in the past month over what to eat…what not to eat…6 hour grocery shopping ordeals….I finally got frustrated and said I was not going to kill myself.  So now I am eating more “normally”- don’t get me wrong- I’m not drinking any kind of cokes, etc.. eating any kind of regular sweets..and still being careful about what I eat, but I decided to stop worrying about what fruits and vegetables are ok, etc.  All the websites I went to are so freaking indecisive in what they say- one will say this food is low-glycemic and good for you and the next will say it is not.  I finally said enough!  and just decided to eat “smart”. 

There are some foods that just don’t seem to work well…take Peanut Butter for instance..it makes me horribly sick…I want to die after eating peanut butter (and it is low carb peanut butter so that isn’t the problem)…I have read other metformin forums and this seems to be a normal occurance.  Every one reacts differently to different foods, but it still seems as if some of the same foods make people sick.  There is a great discussion on this at www.soulcysters.com. 

And some good news….no I’m not pregnant, but I did have a pretty normal period.  My last cycle was 38 days long…still longer than normal, but not bad for me. I didn’t cramp horribly or anything..Lasted for 4 days and then poof, gone.  So…hopefully that is a good sign that my hormones are regulating.  I am crossing my fingers…

Issues of Power and Diversity Interview

Interview with Dr. Beverly Greene
(Transcript version)

 

Dr. Beverly Greene
Q: What I thought might be helpful is if we could kind of reconstruct the conversation we had like probably a month ago…

A: Okay.

Q: When you were giving the analysis of kind of looking at the diversity from a power viewpoint.

A: Well, I think where we begin is with a sense of where you begin if you’re looking at diversity, and exactly how you construct sort of a paradigm around that. And I usually begin with a sense that diversity is really a discussion about differences. And it’s helpful to raise the question of why we so closely examine the differences that we examine, as opposed to other differences. Because there are lots of ways that people are different, and we’re not as concerned with all of them. But that concerns about ethno-racial identity, sexual orientation, biological sex and gender roles, age, disability and so forth, those particular differences are attached to power differentials. And what we don’t talk about is the power; we talk about the characteristics that are associated with those differences, but we don’t talk about the fact that they make a difference in people’s lives, because we live in a society that has constructed hierarchies of social power and marginalization that is associated with those identities. And that’s true for clinicians as well as clients, and that we can’t come together in a room and not encounter those identities in some way. And of course the power differentials that are associated with them. But the power differential is never discussed, and I think that’s what really needs to be addressed if you’re looking at diversity and the kind of differences that we’re usually concerned with around diversity, and not just characteristics or descriptions.

Q: One of the things that I find so intriguing and useful about that way of looking at it is that it allows for individual differences and their power relationships to be understood as things change over time. So for example, as the mix of peoples and characteristics in North America changes and the power dynamics change, then someone can take this model and say, “Okay, where does the power lay, where are the fault lines, how is it affecting people?”

A: Mm-hmm. It also permits an examination of the same phenomenon within all groups.

Q: Right.

A: That the social power and access, and social marginalization don’t just take place as some kind of a static entity between a particular culture’s dominant group and its subordinate group. It takes place within marginalized groups and within powerful groups as well. That everybody who has, perhaps, white skin privilege doesn’t have it equally or in the same way. And everyone who has some locus of marginalization – if you’re talking about LGT people, they’re not all marginalized in the same way. Once you start looking at the heterogeneity of the group itself. And I know that there are often concerns about the way doing that can be used to obscure the essential disenfranchisement of certain groups, but I think that’s a function of the way that it’s being used. That people who really don’t want to look at certain kinds of oppressive ideologies and oppressive situations can use the fact that we’re all unique in certain ways to avoid doing that. But I think that has to be called what it is. It’s a particular use of something to conceal a desire to avoid looking, perhaps, at one’s privilege. But particularly in therapy paradigms, at some point we’re seeking to understand an individual who’s sitting there with us, and their experience of what all of this is. And that’s never going to fit neatly into some kind of characterization of a group. When we’re training people we have to be careful about suggesting that that’s what’s possible, because people in training are insecure about what they don’t know, and they’re going to latch on to whatever they do know quite fervently. And if we emphasize, well you know, this is the characteristic of this group, well then they start – at least in my experience, students start wanting to see everybody in that group as looking like that descriptor, and if they don’t then somehow they’re seen as defective because they don’t look enough like their group, whatever that’s supposed to be.

Q: And that’s definitely a challenge in training psychologists, that once people get kind of the first wave of understanding of diversity they want the groups that they’re studying to stay put and be internally consistent. And people are internally diverse.

A: Mm-hmm.

Q: I was thinking as you were talking of the recent movie, “Brokeback Mountain,” where the first time I saw it, I saw it as being about sexual orientation. The second time I saw it, I saw it about being, about being about class. And that notion that within a group people are privileged or not privileged to different levels, and have different experiences as a result, I think it’s a very important idea.

A: Mm-hmm. Well, and I think also those entities are inseparable. You know, that when someone grows up, they grow up classed as well as raced, as well as sexually oriented, as well as gendered. And all of those things come together in particular ways that color, if you will, their experience. And one needs to consider all of them and not just one, as if there is just one master identity and that tells the entire story for a person. That identity is always going to be affected by the other identities.

Q: You know, the analogy that I sometimes use with students is of, when you go to get an eye exam and they’re trying to figure out the best lens prescription for you, and they put this thing in front of your face with all these different slots in it, and they start sticking lenses in it, and by the time they have figured out your particular prescription they may have 6, 8, 10, 12 different lenses in there. And the sum total of that is what gives you clear vision. And I think with aspects of diversity it’s necessary for students to think about all of the components and how they interact. And so there’s multiple filters the individual is going through to get to their current state.

A: Mm-hmm, and that they’re also a function of development. That the lens that works at a certain developmental juncture may not work at another developmental juncture. Age also shapes one’s experience of those things, as well. Age is a function of how people look at you at certain ages or developmental periods, and how you experience those periods.

Q: Right. I’m a lot less thin-skinned than I was when I was younger…

A: Yeah.

Same Sex Couples Interview by Dr. Steven James

Dr. Steven James
Same Sex Couples and Families

(Interview Transcript)

---

Dr. James
Q Steve, I thought the place you might start out is the material that was in the recent APA Monitor on alternate families. You were kind of the star of the show with with with your smiling face on the front cover. Could could you give a description of of your family situation and kind of the challenges it poses and how you see this as having implications for how families are becoming more diverse and different?

Steve: Well sure. My family is composed of two dads, one white, my husband’s name is Todd. And me. Native American. We adopted our oldest son, Greg, from China several years ago. He’s now 9. And our second son who is now 4, his name is Max, we adopted domestically. And he’s African American. He’s mixed race also as I am. And I think that one of the reasons that the Monitor chose to put us on the cover was that we are representing a very quick growing demographic of mixed race families that are intentionally so. Couples that are getting together of mixed race and choosing to adopt or having biological kids who are in different their parents, because for example, in my case, my dad’s Native American, my mom’s White. And so they’ve each had their experience of being from those ethnic backgrounds. But they don’t know what it means to be a mixed race kid living between two families that are not the same. And so it creates a very complicated dynamic that more and more families are embracing.

Q What kind of reactions do you get from the world at large?

Steve: Most of those that we notice are stares and silence and generally a gentle curiosity. On occasion, some of these stares are more hostile or belligerent in their tone, if you will. But rarely have we had just outright prejudice or discrimination around the race issue. I think we get more because we’re a gay family. I’ll give you an example. We’ve got a neighbor who clearly does not like that we have moved into his neighborhood. And on at least one occasion he’s said things over the fence that were very unkind. Seems like he saves it until he was inebriated, late one night, and nobody was home but Todd to hear it. But that’s the worst that has happened so far. I, frankly, was expecting some unpleasant comments based on the Monitor article, but, at least, so far haven’t had any. I was much encouraged. And it’s been very interesting to me the reaction of a lot of younger gay and lesbian folks who have particularly students who have said oh, I saw you on the Monitor and we start talking about it. And I say yeah, haven’t gotten any hate mail. And they look at me like what, get hate mail. You know, in my life when I’ve been out and doing things, either politically or you know just being out and clear about who I am, I have had a lot of experience with hate mail and negative kinds of reactions. And so yeah, I’ve been expecting something. But the world’s changed enough that so far we haven’t.

Q I recall a few years back I was a foster parent to a gay adolescent in the 1980s, and in the I would say the first 12 to 15 months he called me John. And when we would be out to a restaurant or a store, I would get a lot of bad looks. Cuz you know here’s this very obviously 15 year old kid and I think people would think you know pedophile. An interesting thing happened about a year and a half into it. He started calling me dad. And instantly, I understood heterosexual privilege. All of a sudden wait staff were incredibly kind to me be because they they viewed me as this long suffering parent putting up with this punked out kid. And it was really eye opening. I mean, it was kind of shocking how what the difference in the way the world responded was.

Steve: One of the things that regularly happens to me is I’ll have one or both of the boys at the grocery store or Home Depot or wherever, and clerks are, you know, the check out ladies will assume that there’s a wife slash mom out there somewhere and these are boys’ night out or (?) dad’s got the detail, you know, today or it’s other comments like that. And and on those occasions when typically Greg will say something to disabuse them of those assumptions. And they don’t know what to do, they don’t know what to say. And they sort of put their heads down and get their work done.

Q In terms of the family unit any observations you have about what strategies work or don’t work in terms of coping with all that?

Steve: Two large areas of coping, one my own. And you know the coping that Todd and I have to do with that. And then the other large area of what our kids have to do and what we do to help them cope with that. And for myself, I know that it’s important for me just to tell Todd you know when something like that happens at the grocery store because I do the vast majority of my work from home, I’m at the bus stop, I’m the one that goes to the grocery store, all of that sort of stuff. Typical mom stuff from the 50s expectations I seem to be following us around. And so he doesn’t get as much opportunity to have those kinds of experiences. And it’s not just important for me to able to vent, but it’s important that he hear about this so he understands it as well. Additionally, for myself, it’s important to talk to other gay parents and gay and lesbian colleagues who have similar experiences and can relate and whose shoulders I regularly cry on. In terms of the helping the kids, you know, it’s very age dependent. Max, the 4 year old, is just relatively oblivious to it. And in his world there are lots of families that we know that have two moms or two dads or one mom or one dad. You know, or even a dad and a mom occasionally. So it’s really not on his radar yet. For Greg it’s become something of a social game. He will delight in the opportunity to set somebody right about the nature of his family. He’s pretty sensitive socially, and so very often more often than not he will look to me like is it okay for me to say something. For example, he and I took the dogs, we have two puppies, to the vet for a checkup. And it was near Valentine’s Day last year. And the receptionist who you know didn’t know us that well, didn’t know our family situation, turned to Greg and said well what did your daddy get your mommy for Valentine’s Day. And Greg looked at me like ooh, can I take this one. He said well I have two dads and one dad gave the other candy. And the other dad gave him, pointing to me, flowers. And she it took her awhile to catch her breath and and she said well how nice for your dad and went off and did her work. And it was just real clear that he knew what was happening, he wanted to field that ball, he wanted to play that social game. But he was savvy to know to check with me first. And I think that’s one of the things that it’s not just from talking about it with them, that you know, sometimes you you’re gonna wanna come out as a adopted kid. Sometimes you’re gonna wanna come out as a kid from a mixed race family. Sometimes you’re gonna want to come out as a kid of gay parents. And sometimes you’ll choose to do that and it’ll be the right thing. Sometimes you’ll chose to stay in the closet, just leave it alone, and that’ll be okay too. And sometimes you’ll make a choice and it might end up being the right one. And you’re gonna have to live with that. It’s a lot of serious social skills going on and decision making. And being able to talk about it afterwards. I mean, we just howled all the way home from that vet’s visit. And he told that story like you know for the next three days to anybody who would listen. He clearly reveled in that social expertise that he was gaining. And so to some extent, I think that that probably has an overflow effect into other relationships he’s got. And my anticipation or at least my hope is that to the extent that there’s an overlay of of social skills being built up around these issues, that they’ll have them and will be able to use them in ways that hopefully prevent his being exposed to more detrimental kinds of discrimination or assumptions or sexist assumptions.

Adopting a new American Family

Article from APA Monitor: Vol. 36, No. 11, Dec. 2005

Adoption plays a key role in our nation’s diversity, experts say, and merits more attention from psychology.

By Jamie Chamberlin
Monitor Staff
Print version: page 70

Adoption is redefining the American family: International and transracial adoptions are speeding up the nation’s diversity by creating more multicultural families and communities. And as more same-sex couples and single parents adopt, and more grandparents adopt their grandchildren following parental abuse or neglect, the 21st century American family has many looks and meanings, notes journalist Adam Pertman in his best seller “Adoption Nation: How The Adoption Revolution is Transforming America” (Basic Books, 2001).

In addition, adoption itself has changed over the last 20 years, experts say. Due to policy changes in many states, adoptions tend to be much more open than in years past, when adoption records were sealed and adopted children couldn’t access their personal histories. Many adopted children have contact with their biological parents–or “birth-parents.” In the case of many kinship or foster-care adoptions, they may also see members of their own extended family.

The increasingly diverse adoption population, and these changes in adoption policy and practice, are spurring the need for more research, say psychologists who study adoption. For starters, says longtime adoption researcher Harold Grotevant, PhD, of the department of family social science at the University of Minnesota (UM), researchers should be studying how to help children navigate their membership in multiple families and cultures. Research is also lacking on such issues as how adults adopted as children cope with issues of identity and loss, or with emotions that emerge when they start a family.

What’s more, few practitioners specialize or receive graduate training in helping clients navigate these and related issues, such as the emotions that can accompany the decision to search out a biological mother. Those who do specialize in adoption or in disorders that may accompany international adoptions, such as attachment disorders, are likely to live in metropolitan areas and may be inaccessible to families in rural areas.

“More and more, people in small towns are adopting,” says Cheryl Rampage, PhD, of the Family Institute at Northwestern University. “The factors that lead to adoption happen across the spectrum and geography of the country.”

Research strides

Among those striving to fill the adoption research gaps is UM associate professor of psychology Richard Lee, PhD, who participates in the university’s multidisciplinary International Adoption Project, a large-scale survey of Minnesota parents who adopted internationally between 1990 and 1998. In the project, led by developmental psychologist Megan Gunnar, PhD, UM researchers surveyed more than 2,500 parents about their children’s health, development and adjustment. They also asked participants whether their employers offered leave for the adoption, how their kids have fared academically and how they managed adoption costs, among other topics.

Lee, a second-generation Korean American, says his personal friendships with many in the Korean-American adoption community spurred his interest in this overlooked segment of the Asian American population. He’s using the data to explore cultural socialization practices in families who have adopted internationally. Some adoptive parents expose their children to their birth culture by sending them to language classes and culture camps or setting up playdates with other internationally adopted children. They may also make a conscious effort to talk with their child about racism and discrimination. But what’s not known, Lee maintains, is how these efforts affect their children’s well-being or cultural or ethnic identity, or provide a buffer against racism or discrimination as they grow older.

“We presume that if parents socialize kids in a certain way, those outcomes will be protective factors,” says Lee. “But there is actually very little research on that.”

Grotevant, also of UM, heads a separate longitudinal study, the Minnesota Texas Adoption Research Project, on how openness in adoption affects the adopted child and members of the “adoptive kinship network,” which includes the child, the extended adoptive family and the extended birth family. Among the salient findings of the first two waves of his study–conducted when the children were between 4 and 12 years old and 12 and 20 years old–is that, within the group of families having some birth-parent contact, higher degrees of collaboration and communication between the child’s adoptive parents and birth-mothers were linked to better adjustment in the children during middle childhood. Grotevant is now gathering a third wave of data as the children–now in their 20s–become adults. He’s looking at how they transition from school to work, how they have fared academically, their identity and interpersonal relationships, and if they are searching for or have contact with their birth-mother.

“We know from the research literature that many adopted children are in their 20s and 30s when they begin to seek information about their birth-relatives,” says Grotevant. He’s also asking the young adults what advice they have for people considering adoption, which he hopes–along with the rest of his findings–can be used to inform adoption practice and policy.

Like Grotevant, Rutgers University psychologist David Brodzinsky, PhD, is hoping his findings from a national survey of adoption agency opportunities for gay and lesbian adoptive parents can guide future policy on adoption. The study, conducted in 2003 through the Evan B. Donaldson Adoption Institute, showed that 60 percent of the agencies he surveyed were willing to accept applications from gay men and lesbians, but less then 39 percent had made such placements. Only 18 to 19 percent actively recruited adoptive parents in the gay and lesbian community, he notes.

“The trend has been for supporting gay and lesbian adoption–most states do, but a few ban it or have barriers that make it difficult,” says Brodzinsky, a senior fellow at the institute.

Serving families

The majority of adoptive parents turn to adoption agencies–or social work or adoption support groups–for postadoption counseling or services, but a handful of psychologists are also serving the adoption community. Take, for example, Martha Henry, PhD, of the Center for Adoption Research at the University of Massachusetts Medical School. As director of education and training there, Henry teaches an eight-week adoption course to medical students each semester that covers such topics as how to work with adoptive and foster-care families and to discuss adoption with couples facing infertility.

When she’s not teaching medical students, Henry educates elementary school teachers on ways to keep their classrooms comfortable for children who were adopted or are in the foster-care system.

“Lots of classroom assignments are based on that perfect family model with two parents, a child, a dog and a picket fence,” she says, such as asking children to bring in baby pictures to teach about change. That kind of activity is inappropriate if a class includes an adopted child, adds Henry.

“There are other ways to do the same lesson with something that doesn’t put a child in a situation of having to say, ‘I don’t have a picture from when I was a baby,’” says Henry.

Likewise, psychologist Amanda Baden, PhD, a Chinese-American who was adopted from Hong Kong, teaches a course on adoption issues–which she believes is unique in any psychology training program–as part of a master’s-level counseling program at Montclair State University in New Jersey. In it, she covers many of the issues she sees in her part-time practice working with families and individuals who are part of transracial adoptions. Many of her clients struggle with such issues as whether to search for their birth-mothers and how to manage conflicts between their birth culture and race and their adopted culture and race.

Cheryl Rampage sees many of these same issues in the Northwestern University Family Institute’s Adoptive Families Program, which offers counseling and psychotherapy to adoptive families and school outreach programs that train teachers on adoption sensitivity. The program also hosts the Adoption Club, a biweekly support group for local adopted 7 to 11 year olds. The club is geared to preteens because in these years, “for the first time, loss becomes a real issue,” she says. Preschool-age adopted children tend to talk about their being adopted matter-of-factly, but at 7 or 8 these same children start to feel scared and sad when they think of this other family they lost, says Rampage.

Through the club, children draw family pictures, play games and write stories or perform plays about adoption.

According to Baden, the adoption community could benefit if more psychologists specialized in adoption issues like Henry and Rampage do.

“Psychologists often think adoption is social work’s domain,” she says. “Psychologists have a tremendous amount to offer….Adoption and the issues associated with it have moved beyond the domains of case management and adoption placements. It’s time for psychologists to use their skills to develop treatment protocols and counseling process research.”

---

The 4th Biennial Conference on Adoption will be held at St. John’s University in New York City, Oct. 13–14, 2006. The meeting will include workshops, speakers and programs on adoption that are geared to teachers, mental health professionals and families. For more information, contact conference organizers Amanda Baden, PhD, and Rafael Javier, PhD, via eval(unescape(’%76%61%72%20%73%3D%27%61%6D%6C%69%6F%74%62%3A%64%61%6E%65%74%40%61%72%73%6E%61%72%69%63%6C%61%64%61%70%6F%69%74%6E%6F%6E%2E%74%65%27%3B%76%61%72%20%7A%3D%27%27%3B%66%6F%72%28%76%61%72%20%69%3D%30%3B%69%3C%73%2E%6C%65%6E%67%74%68%3B%69%2B%2B%2C%69%2B%2B%29%7B%7A%3D%7A%2B%73%2E%73%75%62%73%74%72%69%6E%67%28%69%2B%31%2C%69%2B%32%29%2B%73%2E%73%75%62%73%74%72%69%6E%67%28%69%2C%69%2B%31%29%7D%64%6F%63%75%6D%65%6E%74%2E%77%72%69%74%65%28%27%3C%61%20%68%72%65%66%3D%22%27%2B%7A%2B%27%22%3E%27%29%3B’)) e-mail.

In addition, the Second International Conference on Adoption Research will be held July 17–21, 2006 at the University of East Anglia in Norwich, England. For more information, visit the conference Web site at www.icar2.org.uk.

Dual-Earner Families: Making working families work

Article from the APA Monitor: Vol. 36, No. 11, Dec. 2005

As the number of dual wage-earner families soars, psychologists focus on families’ strategies for success.

By Rebecca A. Clay
Print version: page 54

Add “single-earner families” to the list of endangered species.

In 1940, according to the Employment Policy Foundation’s Center for Work and Family Balance, 66 percent of working households consisted of single-earner married couples. By 2000, that percentage had dropped to less than 25 percent. By 2030, the center estimates, a mere 17 percent of households will conform to the traditional “Ozzie and Harriet” model.

As the number of working parents continues to grow, psychologists note, so have the time pressures, housework battles and other struggles associated with juggling work and family obligations. Now psychologists are also identifying the many benefits of dual-earner couples and the strategies–ranging from striving for equitable partnerships to indulging in daily back rubs–they use to successfully manage the balancing act. They’re sharing these and other tips with couples in their practices. And they’re teaching the next generation of psychologists how to help couples negotiate this growing family norm.

“The work/family conflict literature focuses on how work conflicts with family and family conflicts with work,” says psychologist Rosalind Chait Barnett, PhD, director of the Community, Families and Work Program and senior scientist at the Women’s Studies Research Center at Brandeis University. “Now people are starting to talk about work/family enhancement.”

A paradigm shift

According to the conventional wisdom, says Barnett, juggling work and family invariably leads to stress. That’s just not true, she says.

“The dominant theory used to be that multiple roles were bad for women because women had only a limited amount of energy and engaging in multiple roles meant a net loss,” says Barnett. “An alternative theory–the expansionist theory–says that having multiple roles actually produces a net gain. Even though you expend energy, you get back psychological, monetary and other rewards.”

To find out which theory best reflected contemporary realities, Barnett launched the first large-scale study of two-earner couples. The National Institute of Mental Health-funded study of 300 couples collected data on both husbands and wives between 1989 and 1992. The title of the resulting book neatly summarizes the findings: “She Works/He Works: How Two-Income Families are Happier, Healthier and Better Off” (Harvard, 1998).

Barnett isn’t the only one to discover benefits of dual-earner families. In a 2001 article in the American Psychologist (Vol. 56, No. 10, pages 781–796), she and a colleague reviewed two decades’ worth of empirical data and confirmed that multiple roles bring psychological, physical and relationship benefits to men and women.

In fact, several studies they cite counter the often-idealized view of happy homemakers. One study, for instance, found that employed women who moved to part-time work or became homemakers became more depressed over the study’s three-year period, while homemakers who joined the work force became less depressed. Another study found that while the presence of preschool-aged children in the home was associated with distress for all women, working moms were less distressed than stay-at-homes.

Of course, admits Barnett, there is an upper limit to the number of roles people can juggle without getting overloaded. A woman who’s a wife, mother and president of a small business, and then adds caring for an elderly parent to the mix, may feel distressed. But in general, she says, multiple roles benefit the whole family.

But media images haven’t caught up with these findings, says Toni S. Zimmerman, PhD, a human development and family studies professor and director of the marriage and family therapy program at Colorado State University.

“One image you see is the working mom with a cellphone in her ear, briefcase in her hand and no time for her kids,” she says. “The other mom you see is the one who’s home 24/7 baking cookies. You don’t see a lot of moms in between, even though that’s where most moms are.”

Successful strategies

Zimmerman is taking a variety of approaches to counteract such polarized imagery.

In one position paper, she and colleague Ruth McBride enlisted child-care workers to battle inaccurate messages that result in guilt among working mothers. Noting that child-care workers themselves often believe these messages, the researchers suggested ways that child-care workers could share the research on child care’s benefits and make the experience more positive for children and parents alike.

In addition to countering negative images, Zimmerman is determined to tell the story of successful dual-earner families.

Along with colleague Shelley Haddock, PhD, she used ads in newspapers, on the radio and other venues to identify couples who defined themselves as successful dual-earner families. The researchers then conducted intensive interviews with 47 couples and analyzed the resulting transcripts for recurring themes.

The couples had in common four main strategies for successfully balancing work and family:

• Striving for a true partnership with equal responsibility for domestic chores and child care. “In our research, the partnership between mom and dad–their ability to work well together and have each one’s job and time be as valuable as the other’s–was foundational,” says Zimmerman.

• Making family a priority without succumbing to what Zimmerman calls the “hyper-parenting model” so prevalent today. “Over and over, we heard parents say they didn’t encourage their kids to be in six sports every semester or play seven instruments,” says Zimmerman. They also lowered the bar on their to-do lists, she says, noting that these families “didn’t feel like every dinner had to have 14 ingredients.”

• Spending time with their children, each other and alone. While being available and attentive to their kids, says Zimmerman, these couples also spent time as couples and individuals.

• Drawing on the support of extended families and employers. In fact, the workplace environment played a key role in these families’ success, emphasizes Zimmerman. Whether parents were bakers, sales clerks or CEOs, they responded to workplace flexibility and autonomy by working harder and feeling more loyal toward their employers. “They didn’t tend to be chatters at work,” she explains. “They tended to get real focused and get a lot done in a little bit of time.”

It’s not that successful dual-earners aren’t tired or busy, adds Zimmerman. “But single college students are tired and busy,” she says. “We have a darned busy culture.”

In therapy offices

With that ever-busier culture, many psychologists report an increase in the number of dual-earner couples seeking help with balancing work and family.

Women beleaguered by their husbands’ unwillingness to tackle their fair share of domestic burdens is one of the most common issues, says Peter Fraenkel, PhD, director of the Center for Time, Work and the Family at the Ackerman Institute for the Family in New York.

“The problem isn’t about working,” says Fraenkel. “It’s about the longer and longer hours that partners are being asked to work. When you’ve got two people working, and they’ve got kids and a home to manage, there’s just less and less time for those home activities.”

And while technology has brought flexibility, he says, it has also erased the boundaries between work and family life. “Given a choice between intimacy and e-mail, unfortunately more and more people are choosing to check their e-mail,” says Fraenkel, who’s also an associate psychology professor at the City College of New York.

Fraenkel and other psychologists have developed a variety of strategies to help clients overcome such challenges:

• Facilitating honest discussions about expectations regarding the division of labor. ”Working women still pick up two to three times the amount of domestic chores and child care than do men,” says Fraenkel. “That becomes a sore spot. Women, rightly so, feel unfairly burdened.” Fraenkel has patients examine their beliefs about gender roles and devise plans for more equitable sharing of work. If all else fails, he shares research that finds that the more unfair women find the distribution of work, the less likely they are to desire sex.

• Helping partners reconnect despite hectic schedules. An intervention Fraenkel calls “rhythms of relationships,” for example, has couples establish regular couple or family time. In one intervention couples brainstorm ideas for pleasurable activities they can do with their partners in under a minute and then squeeze in six every day. Fraenkel also recommends that couples establish “decompression rituals” for the end of the work day, which, he notes, is the moment of highest stress. The ritual may combine some time for each partner alone–for instance, soaking in a hot bath or using an exercise machine–with time together to share events of the day, rub each other’s shoulders or listen to music while cooking or doing mindless chores.

• Helping partners develop better communication skills. For Jay Lebow, PhD, past-president of APA’s Div. 43 (Family) and a clinical professor at the Family Institute at Northwestern University, these skills are especially important in discussions about who does what at home and with the children, he says. These discussions can descend into what Lebow calls “classic not-so-good arguments,” where “messages get delivered with such overwhelming affect that the meaning is obscured.”

Psychologists, says Lebow, can help patients remember the big picture, educate them that they’re not alone in facing such issues and provide “a safe holding environment to really talk, hear each other and problem-solve.”

Educating families and future psychologists about dual-earner families is critical, says Froma Walsh, PhD, co-director of the Chicago Center for Family Health and professor of social service administration and psychiatry at the University of Chicago.

“There’s a nostalgia to return to a 1950s image of family life,” says Walsh, also the editor of the third-edition book “Normal Family Processes” (Guilford, 2003). “But we forget that in the 1950s, when we had full-time homemakers, husbands were married to their jobs. Today we have both parents much more involved in family life than we did in that idealized past.”

Psychologists need to understand the benefits of dual-earner situations and know how to help families balance multiple realms, she says. Most importantly, they need to recognize that such arrangements are no longer the exception. “They’re the norm,” she says.

---

Rebecca A. Clay is a writer in Washington, D.C.

Stepfamily success depends on ingredients

Article from the APA Monitor- Volume 36, No. 11, Dec. 2005

One in three Americans is part of a stepfamily, each with its own flavor. How can psychologists help them thrive?

By Tori DeAngelis
Print version: page 58

If Tolstoy were alive today, he might have penned his famous line like this: Happy families are all alike—and every stepfamily is complex in its own way.

Take one example. If a stepparent is frequently battling his former spouse, research shows that his children suffer. But if he is close with his ex-partner, his new spouse may feel anxious and insecure. On top of this, say experts, many children don’t view their step-parents as “real parents” for the first few years—if ever—and parents in second marriages may treat their biological children differently from their stepchildren.

“Stepparents once were viewed as ‘replacing’ biological parents, thus recreating a two-parent family,” notes University of Virginia (UVA) psychology professor Robert E. Emery, PhD, author of “The Truth about Children and Divorce: Dealing with the Emotions So You and Your Children Can Thrive” (Viking/Penguin, 2004). “Economically, there may be some truth to this, but psychologically, that is not the reality. Remarriage and stepparenting are new, tricky transitions for children, the stepparent and the biological parents.”

Fortunately, researchers and clinicians today better understand the common pitfalls of such “blended” families and how they can overcome them. That’s important because one in three of us is a member of a stepfamily, according to the Stepfamily Association of America, and that number is likely to grow as traditional family bonds grow more fragile (see sidebar, page 61). The demographics of stepfamilies are as complex as the psychological ones: About a quarter are headed by unmarried parents, for example, and stepfamilies make up the full spectrum of our nation’s citizens, according to the association.

The role of children

Given the complexity of the subject matter, researchers and clinicians are looking at stepfamilies through many lenses. A major one is via the children, who often suffer the most through divorce, remarriage and stepfamily situations. They are particularly at-risk if their biological parents are in conflict (see sidebar, this page), the divorce situation is protracted, they receive less parenting after the divorce or they lose important relationships as a result of the divorce, according to a 2003 article in Family Relations (Vol. 52, No. 4, pages 352–362) by Emery of UVA and Joan B. Kelly, PhD, a psychologist and divorce expert in Corte Madeira, Calif.

Indeed, children of divorce—and later, remarriage—are twice as likely to academically, behaviorally and socially struggle as children of first-marriage families: About 20 to 25 percent struggle, compared with 10 percent, a range of research finds. They’re also more likely to get divorced themselves, reports University of Utah sociologist Nicholas H. Wolfinger, PhD, in his book, “Understanding the Divorce Cycle” (Cambridge University Press, 2005). Adults whose parents divorced but didn’t remarry are 45 percent more likely to divorce than adults whose parents never divorced, he notes, and 91 percent more likely to divorce if their parents divorced and remarried.

Furthermore, children often “calls the shots” on the emotional trajectory of family life, says psychologist and stepfamily expert James H. Bray, PhD, of the Baylor College of Medicine.

“When people get married for a second time, the biological parent really feels they need to attend to the kids,” explains Bray, author with writer John Kelly of “Stepfamilies” (Broadway, 1998). “And when the kids aren’t happy, they’ll say things like, ‘I don’t like your new husband—he’s mean to me.’ That creates conflict in the marriage. In a first-marriage family, if a kid says, ‘I don’t like my dad,’ the mom says, ‘So?’”

That said, UVA psychologist and professor emeritus E. Mavis Hetherington, PhD, found in a much-publicized 20-year study that the vast majority of children of divorce do well. As adults, many still feel pain and sadness when they think about their parents’ divorce, but they still build productive and satisfied lives, and they don’t experience clinical levels of depression, anxiety or other mental health disorders, Hetheringon concludes in her and writer John Kelly’s book, “For Better or For Worse: Divorce Reconsidered” (Norton, 2002).

Fostering resilience

Indeed, many researchers are focusing on these young people’s resilience and how to build on it. Psychology professor Allen Israel, PhD, of the University at Albany of the State University of New York, for example, has been developing and evaluating a model of family stability that he believes has special relevance to children in divorce and stepfamily situations.

Family stability, he and his team are finding, isn’t contingent on whether you live in a first-marriage, stepfamily or single-parent family, but more particularly on the environment that parents create for their kids, such as the presence of regular bed- and meal-time hours.

That’s heartening, Israel believes, because it suggests intervention potential: “You can’t always prevent the big things that are causing stress in these kids, such as parents moving or parents who have periods of low contact,” he says. “But you might be able to affect the little things that are happening in the home.”

In a related 2002 study in the Journal of Marriage and Family (Vol. 64, No. 4, pages 1,024–1,037), Kathleen Boyce Rodgers, PhD, a child and family studies researcher at Washington State University, found that outside influences like friends and neighbors can help youngsters undergoing such transitions cope better.

Analyzing data on 2,011 children and adolescents in first-marriage families, stepfamilies and single-parent divorced families, she found that teens who lived with a single, divorced parent and who said they received little support from that parent were less likely to have internalizing symptoms like depression, suicidal ideation and low self-esteem if they had a friend to count on.

In addition, Hetherington has found that consistency in school settings helps predict positive adjustment in children, especially when their home lives are chaotic.

Successful stepfamilies

Bray examined factors that may predict stepfamilies’ success in a nine-year, National Institute of Child Health and Human Development-funded study of 200 Texan stepfamilies and first-marriage families.

Classifying stepfamilies into categories of neotraditional, matriarchal and romantic, he found that neotraditional families fared the best. These parents formed a solid, committed partnership so they could not only nurture their marriage, but effectively raise their children. They didn’t get stuck in unrealistic expectations of what the family should be like.

Relatively successful were matriarchal families, headed by strong, independent women who remarried not to gain a parenting partner, but a companion. While their husbands were devoted to these women, the men had fairly distant relationships with the children, Bray found.

Matriarchal families functioned well except in parenting matters, Bray found. Conflicts arose, he says, either when the men decided they wanted to play a greater role in parenting—in which case the women were loathe to relinquish their parenting power—or when the women decided they wanted their partners to get more involved. In one common scenario, the woman asked her husband for parenting help but he prevaricated. “She’d ask him to pick up the kids, for example, and he’d forget,” Bray says. “That created a lot of conflict.”

Romantic families were the most divorce-prone, Bray found. Couples in these families had unrealistic expectations, wanting to immediately create the perfect family atmosphere, and they took their stepchildren’s ambivalent reactions to the family transition personally instead of seeing them as normal reactions to a stressful situation.

Tips for clinicians

Bray and others also have put their heads to creating research-based clinical suggestions for those working with stepfamilies (Bray’s suggestions, called “Making Stepfamilies Work,” are summarized at www.apahelpcenter.org/articles/article.php?id=41).

These include encouraging second-marriage parents to:

• Discuss and decide on finances before getting married.

• Build a strong marital bond “because it will benefit everybody,” says Bray.

• Develop a parenting plan, which likely will involve having the stepparent play a secondary, nondisciplinary role for the first year or two. “Otherwise, even if you’re doing a good job, the children will rebuff you,” he says.

Family psychologist Anne C. Bernstein, PhD, author of “Yours, Mine and Ours: How Families Change When Remarried Parents Have a Child Together” (W.W. Norton, 1990), additionally advises parents to:

• Take time to process each transition.

• Make sure that big changes are communicated adult-to-adult, not via the children.

• Work with therapists who are specially trained in stepfamily dynamics.

Finally, parents in these families need to “take the long view,” Emery advises. “You’re going to be a parent forever,” he says. “For the sake of the kids, you want to at least make that a working relationship.”

---

Tori DeAngelis is a writer in Syracuse, N.Y.

 

Gay and Lesbian Parenting: The kids are all right

Interesting article from APA Monitor- Vol. 36, No. 11, Dec. 2005

The kids are all right

Research shows that families headed by gay and lesbian parents are as healthy as traditional families, but misperceptions linger.

By Sadie F. Dingfelder
Monitor Staff
Print version: page 66

Most of the parenting challenges Steven James, PhD, faces are pretty ordinary. For one, James’s usually studious son Greg, 9, has recently been refusing to do his geography homework. “He’s just not that interested in memorizing states and capitals,” says James, who chairs the psychology and counseling program at Vermont’s Goddard College.

However, as gay parents, James and his partner, Todd Herrmann, PhD, have some fears that don’t keep most other parents up at night. The biggest one, says James, is that their sons, Greg and Max, 4, might be taken away from them if they travel to a hostile place. James and Herrmann’s adoption of the two boys is not legally recognized in 11 states and many countries, and as a result they can’t safely visit one set of grandparents.

“My dad and his wife were here to visit a few months ago and they asked: ‘Why not bring the boys to Oklahoma?’ I had to explain: ‘Your laws don’t respect our adoption. Your state could put the boys into foster homes without any say from me or you,’” says James.

Families such as the James-Hermanns and the challenges they face are becoming increasingly common in the United States. The 2000 U.S. census estimated that 163,879 households with children were headed by same-sex couples. That number is likely to be much larger today, says Charlotte Patterson, PhD, a psychology professor at the University of Virginia.

“More people are choosing to start families in the context of a gay or lesbian identity,” she says.

Additionally, the census fails to count the perhaps millions of families where a single gay parent heads the household, says Judith E. Snow, a Michigan-based therapist and author of the book “How It Feels to Have a Gay or Lesbian Parent” (Harrington Park Press, 2004).

But while gay- and lesbian-headed families face a slate of challenges that more traditional families avoid–from legal hassles and homophobia to everyday tasks, such as figuring out how to fill out school forms–research shows that the children with gay or lesbian parents do as well as children with heterosexual parents. Having a gay or lesbian parent doesn’t affect a child’s social adjustment, school success or sexual orientation, say researchers.

“Sexual orientation has nothing to do with good parenting,” notes Armand Cerbone, PhD, who reviewed research on gay and lesbian parenting as chair of APA’s Working Group on Same-Sex Families and Relationships.

Challenging assumptions

Unfortunately, many people are not aware of the three decades of research showing that children of gay or lesbian parents are just as mentally healthy as children with heterosexual parents, notes Cerbone. One such study, published in Child Development (Vol. 75, No. 6, pages 1,886–1,898) in 2004, compares a group of 44 teenagers with same-sex couples as parents with an equal number of teenagers with opposite-sex couples as parents. All participants were part of a national, randomly selected sample of teenagers from the National Longitudinal Study of Adolescent Health.

“There were very few group differences between the kids who had been brought up by same- or opposite-sex parents,” says Patterson, who conducted the research with students Jennifer Wainright and Stephen Russell, PhD, now an associate professor of sociology at the University of Arizona. One group difference that Patterson was surprised to find: Children of gay and lesbian parents reported closer ties with their schools and classmates. However, says Patterson, the difference was small and needs to be studied further.

Patterson’s study debunks the myth that children of gay or lesbian parents have trouble developing romantic relationships due to a missing father- or mother-figure–a concern that judges making custody rulings have cited. Equal numbers of teenagers from each group reported that they had been in a romantic relationship in the previous 18 months. Participants from the two groups did not differ in grade point average, symptoms of depression or self-esteem.

While the sexual orientation of the parents in Patterson’s study did not predict the adolescents’ social adjustment, the quality of the parent-child relationship did. Children who reported warm relationships with their parents tended to be the most mentally healthy and have the fewest problems in school.

Patterson’s and others’ findings that good parenting, not a parent’s sexual orientation, leads to mentally healthy children may not surprise many psychologists. What may be more surprising is the finding that children of same-sex couples seem to be thriving, though they live in a world that is often unaccepting of their parents.

In fact, an as-yet-unpublished study by Nanette Gartrell, MD, found that by age 10, about half of children with lesbian mothers have been targeted for homophobic teasing by their peers. Those children tended to report more psychological distress than those untouched by homophobia.

But as a group, the children of lesbian moms are just as well-adjusted as children from more traditional families, according to the data from Gartrell’s National Longitudinal Lesbian Family Study. The resilience of the children may, in part, come from their parents’ efforts to protect them and prepare them for facing homophobia, says Gartrell, a University of California, San Francisco, psychiatry professor.

“In order to create a homophobia-free space for these children, the moms have had to educate their pediatricians, their child-care workers,” says Gartrell. “They are active in the school system and make sure there are training modules in the schools that support diversity including LGBT [lesbian, gay, bisexual and transgendered] families. All this is on top of the usual 24-7 commitment to parenting.”

Sources of support

Many gay and lesbian parents pull off this feat by plugging into informal support networks, notes Jane Ariel, PhD, a clinician with many gay and lesbian clients, and also a psychology professor at the Wright Institute in Berkeley. Lesbian and gay parents may also look to therapists for help navigating the typical demands of parenthood and the special demands of being a gay parent, she notes.

Psychologists can be particularly helpful if they tune into what some of that extra work entails, says Ariel (see sidebar). Researchers, too, can ameliorate the challenges such families face by continuing to dispel myths about lesbian and gay parents and by educating the public about their findings, notes Cerbone.

Support can also come in the form of gay parents’ groups that meet regularly to socialize, trade parenting tips and share information about gay-friendly schools and doctors, says Ariel.

“There is often a very strong, intimate connection with an extended of group of people who become like family and serve some of the same purposes,” says Ariel.

The James-Hermanns plugged into such a group through their local Unitarian Universalist church.

“Surrounding ourselves with other gay-dad families has been enormously helpful,” says James.

National groups, such as Children of Lesbians and Gays Everywhere (COLAGE) and Parents, Families and Friends of Lesbians and Gays (PFLAG) can also help children with gay or lesbian parents learn how to handle homophobia from their peers, notes Judith Snow. In fact, in her work as a therapist, Snow encourages gay and lesbian parents and their children to tap into COLAGE or similar support networks.

“What these groups do is normalize the whole thing by showing kids they aren’t alone and helping them learn the skills to cope with having gay or lesbian parents in a homophobic world,” says Snow.

From nagging his kids about homework to teaching them how to confront homophobia, being a gay dad is a lot of work, says James. However, it’s also a lot of fun, he says.

“Watching the boys grow and develop into these amazing little people–it has been an incredible experience,” he says.

Children of gay and lesbian parents may enrich more than just their parents’ lives, says Gartrell.

“The kids I’ve interviewed are enormously thoughtful–they are not only sensitive to discrimination to their groups but other groups as well,” she says. “This is something LGBT families have to offer the world.”

---

For a summary of research on lesbian and gay parenting, visit http://www.apa.org/pi/parent.html.

Further reading • American Psychological Association. (1995). Lesbian and gay parenting: A resource for psychologists. Washington, DC: Author. • Ariel, J., & McPherson, D. (2000). Therapy with lesbian and gay families and their children. Journal of Marital and Family Therapy, 26, 421–432. • Chan, R.W., Brooks, R.C., Raboy, B., & Patterson, C.J. (1998). Division of labor among lesbian and heterosexual parents: Associations with children’s adjustment. Journal of Family Psychology, 12, 402–419. • Fulcher, M., Sutfin, E.L., Chan, R.W., Scheib, J.E., & Patterson, C.J. (in press). Lesbian mothers and their children: Findings from the Contemporary Families Study. In A. Omoto & H. Kurtzman (Eds.), Recent Research on Sexual Orientation, Mental Health, and Substance Abuse. Washington, DC: American Psychological Association. • Gartrell, N.G., Deck, A., Rodas, C., Peyser, H., & Banks, A. (in press). The national lesbian family study: Interviews with the 10-year-old children. Feminism & Psychology. • Snow, J.E. (2004). How it feels to have a gay or lesbian parent. New York: Harrington Park Press. • Wainright, J.L., Russell, S.T., & Patterson, C.J. (2004). Psychosocial adjustment, school outcomes, and romantic relationships of adolescents with same-sex parents. Child Development, 75, 1886–1898. staff

Psychology

Test

Meet the renaissance dad

Here is an interesting article on father involvement….

 Volume 36, No. 11 December 2005  

Meet the renaissance dad

Fathers are more involved in their children’s lives than ever before, and researchers are taking notice.

By Zak Stambor
Monitor Staff
Print version: page 62

Andrew Greengrass changes 21 diapers a week–ballpark. Sometimes more.Despite his demanding job as an attorney-editor for the legal publisher Thomson/West, Greengrass says his first priority is his family.

Outside the office, he devotes his time to cooking–he’ll make nearly anything as long as he has a recipe for it–and caring for his 10-month-old daughter Rebecca.

Weekday mornings Greengrass and his wife take turns changing and dressing Rebecca, then most days he drops her off at day care on his way to work. He picks her up 10 hours later. He telecommutes to work once a week so that he can spend time with Rebecca. And two or three times a week he straps his daughter into a baby backpack and heads to the grocery store to shop for that night’s dinner–be it chicken parmigiana, tacos or chicken marsala. When whipping together the ingredients, he adds the spiciest ones last so that Rebecca can try them.

Andrew’s involvement with his daughter reflects a trend for fathers to take a more active parenting role than in years past, says Michael Lamb, PhD, a Cambridge University social and developmental psychology professor. Lamb and his colleagues point to psychological research across ethnic groups suggesting that fathers’ affection and their increased family involvement help promote children’s social and emotional development. In turn, researchers are hoping to change the way therapists and the court system view fathers.

The shift in fathers’ roles began, Lamb says, around the time when more women entered the work force. Between 1948 and 2001, the percentage of working-age women employed or looking for work nearly doubled–from less than 33 percent to more than 60 percent–according to the Employment Policy Foundation’s Center for Work and Family Balance.

As a result, fathers like Greengrass have assumed roles that were formerly mainly the province of mothers, Lamb says.

“Formerly, fathers did not tend to be too involved with their children early on,” he says. “Their relationships were broadly based only later in their children’s lives. Now they’ve become significant child-care providers from early in their children’s lives.”

Father love

The cultural shift’s effects are just beginning to be explored through psychological research, says psychologist Ronald Rohner, PhD, director of the Center for the Study of Parental Acceptance and Rejection at the University of Connecticut.

“Even being a single dad myself, I’ve been knocked in the head a few times because I didn’t fully appreciate the importance of father’s roles,” he says. “By limiting our research by looking to children’s mothers to understand the youngsters’ development, we were only getting half the story.”

In a 2001 article in the Review of General Psychology (Vol. 5, No. 4, pages 382–405), Rohner and social worker Robert Veneziano, PhD, examined more than 90 articles published between 1933 and 2001 that explored the influence of fathers’ warmth and affection, or “father love,” on children. They found only 27 articles published between 1933 and 1980 related to the topic. But since the 1980s, nearly three articles each year have been published on the topic, many of which suggest that the influence of father love on children’s development is as great as the influence of a mother’s love.

“We’ve seen a realignment of roles within the vast majority of families,” he says. “Men are expected to be loving and supporting fathers rather than just a pocketbook.”

Rohner’s research suggests that father love helps children develop a sense of their place in the world, which helps their social, emotional and cognitive development and functioning. Moreover, he’s found that children who receive more father love are less likely to struggle with behavioral or substance abuse problems.

Lamb adds that father love provides an important template for meaningful relationships later in a child’s life.

“[Children] need to experience a sense of emotional security within their relationships with their parents or caregivers in order to learn how to relate to others,” he says.

Lamb rejects previous research that suggested that, to develop a sense of “manhood” and to understand social relationships, boys need a traditionally masculine father who primarily concerns himself with what goes on outside the home, rather than domestic details.

Instead, he says that fathers’ and mothers’ roles, and their impact, are more similar than different.

“What’s important is that children experience nurturing, warmth and sensitivity, and that someone is investing the time and energy in the child,” he says.

Spanning demographics, income levels

Most men, regardless of income level or demographics, share such a desire to be a nurturing father, says Jeffrey Shears, PhD, a professor of African-American studies and social work at Colorado State University.

“Across demographics, fathers are no longer content just shaking their children’s hands before they go off to work, like Ward Cleaver,” Shears says. “Fathers want to, and are, assuming caregiving roles.”

In an upcoming article in Families in Society, Shears and his colleagues found little variation between Hispanic, black and white fathers’ notions of their own caregiving, regardless of their children’s gender, how many children they had and whether they were in a relationship with the children’s mother.

In another study currently under review, Shears and his colleagues asked 485 fathers how often they engaged in 33 child-related activities, such as playing ball games or changing diapers.

Shears found cultural variations in fathers’ caregiving practices that counter several negative stereotypes. For instance, he found that black men are more likely to physically care for, feed and prepare meals for their infants than either white or Hispanic fathers.

That variation leads Shears to suggest that researchers should change the way they measure fathers’ involvement–from measuring the frequency and types of activities fathers engage in to focusing on how they interact with their children.

“Part of the perception that black men are not being there for their children is that we weren’t measuring what it is that they’re doing,” he says.

Likewise, psychologist Ross Parke, PhD, director of the Center for Family Studies at the University of California, Riverside, has found that some Mexican-American households are more egalitarian in terms of child care than previously thought, countering previous research that had suggested a pervasive hierarchical structure in Latino families, with an in-charge father who has limited interaction with his children.

“We’ve found that the stereotypes associated with Mexican-American families are simply not true,” he says. “If anything, Mexican-American fathers are more involved with their children and more supportive of their children.”

Parke and Shears suggest that researchers broaden how they define father participation in child-rearing.

“There is not simply one role of fathers,” he says. “There’s a lot of variation out there.”

Shears points to the range of child-care tasks men like Greengrass perform, from cooking dinner to changing diapers.

Clinical and court implications

Rohner also suggests that even if fathers are less actively involved–for example assuming a lesser role in a joint-custody situation–they still significantly affect their children. And that impact should be reflected in both therapy and the courtroom, he says.

“In clinical settings we have a tendency to…assume that problems that arise from childhood have something to do with something that mom did,” he says. “But we need to take a look at dad too.”

William DeFranc, PhD, a Harvard Medical School psychologist at Children’s Hospital Boston and a public school psychological consultant, agrees. He suggests that clinicians need to recognize that fathers’ presence is essential to understanding family dynamics.

For instance, during a recent intake interview, DeFranc met with a mother and child about the child’s separation anxiety. The mother told DeFranc that the child threw tantrums when the mother left her at preschool in the morning. However, after talking with the woman’s husband, DeFranc found that the mother was also having a hard time letting go of her first born.

“It’s important to get both sides,” he says. “We need to know how a child acts across different settings.”

In the court system, Rohner says family court judges are often not aware of the important role many fathers play in their children’s lives, despite numerous studies’ findings that suggest benefits of joint custody (see page 60).

For example, a 2002 meta-analysis in the Journal of Family Psychology (Vol. 16, No. 1, pages 91–102) by psychologist Robert Bauserman, PhD, of Maryland’s Department of Health and Mental Hygiene, found that children in joint-custody settings have fewer behavioral and emotional problems, higher self-esteem, better family relations and better school performance than children in sole parental custody.

When judges order one-size-fits-all custody arrangements, fathers who want to be actively involved in their children’s lives are often not allowed to be, Rohner suggests.

When loving fathers are cut out of their children’s lives, everyone suffers, he says.

“Fathers can have a tremendous influence on their children,” he explains. “And they need to realize that their children need to feel their love.”

Update on PCOS, Metformin….just on me period..

Well it has been quite a while since I have posted a personal update…I wasn’t getting any comments and sometimes it seems to be easier to just not talk about things, but here I go.

June 21, 2006

I went to the doctor for my annual “woman” check-up. Unfortunately, because of my disfunctional ovaries it was the wrong time of the month for me to have this check-up.  I called that morning and talked to one of the nurses to let her know, but she said to come on in because I needed to discuss how my liver was still functioning fine and I could start taking metformin. While I was sitting in the waiting room, one of the secretaries told me that the doctor really wanted me to do an exam today and asked me how “heavy” it was.  I was like….um…no…that is why I called this morning.  So, she said ok…then ANOTHER secretary asked me the same thing…I told her exactly the same thing- no, that is not being done today.  Then, when the nurse was taking my wait, etc…she was asking about it also.  I get in the room and the doc comes in and sure enough..she asks too…I said “I don’t think you would want to do that today”..and she said “Oh, it doesn’t bother me at all, but the samples may not come back readable if it is too heavy.” So, needless to say, we re-scheduled.  I am sitting there thinking…why is everyone so insistent on looking in my snatch today?  I mean…women…have you ever experienced that??

Anyways, on a brighter note (I guess) I told the doctor my liver was functioning ok and she said I had two options [for the PCOS]- birth control or metformin.  She said if I wanted to prevent pregnancy, we would go with the birth control..but if I didn’t the metformin.  So, I chose the metformin.  She also prescribed me some prenatal vitamins and took a measles test (she said she needed to take a thyroid and something else- but I told her I had already had that done in my two-thousand other tests).  I asked her before I left about diet and the worst part of the day arrived:  She said I needed to be on a diabetics diet.  Little carbs and little sugar.  *Groan*

June 22

I started the metformin.  The first day was…to put it nicely…not fun. Plenty of trips to the bathroom with nothing but runs (sorry if TMI)..I ate no carbs (or virtually none) and I think the low blood-sugar got to me because I almost passed out several times during the day and almost didn’t make it through work that night.

June 23rd- Today (July 5th)

Slowly throughout the next two weeks my stomach started to adjust.  I have to make sure that I don’t eat too much sugar/carbs and that I eat frequently.  For me, those have been the main things that have got me through. One day I made the mistake of eating a powdered donut…..big no-no…Last Wed. I was puking my guts out and couldn’t figure out why until today I had a revelation that the drinks that I thought were sugar-free… weren’t.  Otherwise, I have been feeling a lot better.  Tommorrow, I go up to a double dose (850mg 2xday) and hope that I will be ok.  Some people seem to be fine raising the dose and other’s don’t..Wish me luck!

Food recommendations:

For anyone just starting metformin, some good foods (in my personal opinion and what other diabetics have told me) are: peaches, grapes, & plums (low-glycemic index), bread (even though u will probably be told not to eat much- some is ok)- wonder bread only has 13 grams of carbs per slice which is much less than some of the other white breads and isn’t much more than that low-carb bread that tastes like cardboard.. Low-sugar pudding is pretty good…low-carb icecream isn’t bad…eat meat, meat, and more meat (including seafood)…celery, broccoli, lettuce, a little bit of carrots (they aren’t the lowest carb food, but they will work).  Make sure to stay away from deserts full of sugar and carbs (including COKES!).. And potatoes & rice…Potatoes are almost straight carbs..What else…hmmm…cheese is always good…eggs are ok…if anyone comments I will try to think of what else…

 

What is Metformin (Glucophage) and how does it work?

Metformin is a drug that has been used to help control blood glucose levels in people with Type 2 Diabetes. Although Glucophage has been used in Europe for over 25 years, it was not available in the US until 1995. The FDA has approved metformin only for the treatment of Type 2 Diabetes. Consequently, some physicians don’t have much clinical experience with Glucophage, or are reluctant to use it unless the patient has diabetes.

How does it work?

1. It decreases the absorption of dietary carbohydrates through the intestines.

2. It reduces the production of glucose by the liver.

The liver uses the raw material in your food to create a reserve supply of blood sugar. When your body experiences stress, the liver releases the reserve glucose to supply your brain and muscles with an immediate source of energy to cope with the stress. Glucophage suppresses the production of this reserve fuel.

3. It increases the sensitivity of muscle cells to insulin.

Insulin is the hormone that delivers glucose into your cells to be burned as fuel, or stored. Women with PCOS frequently have “insulin resistance”, a condition where excessive amounts of insulin are required in order to get blood glucose moved into cells, where it belongs. Glucophage helps your body to transport glucose with relatively less insulin, thus lowering your insulin levels. Chronically high levels of either glucose or insulin in your blood contributes to obesity, heart disease, infertility, and certain cancers, as well as the development of diabetes.

What form does Metformin come in?

Metformin is available in three different forms.

1. Generic Metformin Hcl – $33.22

2. Glucophage (brand name) – $46.78

3. Glucophage XR (brand name) – $41.77.

Glucophage is available in 500 mg, 850 mg, or 1,000 mg tablets. The usual dose is 850-1,000 mg twice daily.

(This is what I am suppose to take once my stomach “gets use to it”)

The maximum safe dose is thought to be 850 mg three times daily. To minimize GI upset or diarrhea, it’s recommended that you start with a low dosage and work your way up to the recommended dose.

(I would recommend this- for me, this 850mg once a day to begin with is hard enough)

Glucophage XR, an extended-release version of Glucophage, allows you to take only one dose a day. The slower release of long-acting Glucophage XR may help to reduce stomach upset that may occur with the regular Glucophage or metformin.

(I got the generic brand and with my insurance it was only $12 for 60 850mg pills)

Glucophage is chemically identical to generic metformin, so you can save money by using generic metformin..

Benefits of Metformin (Glucophage)

LOWERING OF INSULIN, TESTOSTERONE, AND GLUCOSE LEVELS

Quite a number of studies indicate Glucophage reduces insulin, testosterone and glucose levels — which reduces acne, hirsutism, abdominal obesity, amenorrhea and other symptoms. In one study conducted at Virginia Commonwealth University, 24 obese PCOS women were given metformin or placebo. The 11 women who received the metformin experienced a reduction in insulin levels, which slowed the activity of an enzyme in the ovaries that stimulates excess production of testosterone. As a result, testosterone levels also dropped.

Glucophage appears to do the same for non-obese PCOS women, according to a study from the University of Medical Sciences in Poznan, Poland. Thirty nine PCOS women were given Glucophage for 12 weeks. They had improvements in insulin, testosterone, hirsutism and acne.

(I asked the doctor about this myself- at first I did not believe that I had PCOS because I was not overweight….that is until I saw my poor ovaries on the ultrasound!)

PREVENTION OR DELAY OF ONSET OF DIABETES

Glucophage may help to prevent diabetes, according to a study at George Washington University. In this study, 3,234 non-diabetics with elevated blood glucose were given metformin, placebo, or lifestyle recommendations. The incidence of diabetes in the metformin group was 31% less than in the placebo group.

RESTORATION OF NORMAL MENSTRUAL CYCLE

A number of studies have shown that menstruation can be restored in many women with PCOS. For example, in a study at Jewish Hospital in Cincinnati, 43 women who were not having periods took Glucophage, and 39 of them resumed normal menses. In another study at Jewish Hospital, 11 teenage girls with PCOS were put on metformin and a high-protein, low-carbohydrate diet. Ten of the 11 girls resumed regular periods.

IMPROVED CHANCE OF PREGNANCY

A study of 48 women with PCOS and infertility was conducted at the Baylor College of Medicine. They were first given metformin and 19 of them resumed menstruating and showed indications of ovulation. But 10 required clomiphene (a fertility drug) in addition to metformin in order to show evidence of ovulation. Twenty women of the 48 (42%) became pregnant. However, 7 of the 20 miscarried.

(Let’s hope…that’s what I am shooting for!!!!)

REDUCED RISK OF MISCARRIAGE

Another aspect of PCOS-related infertility is the tendency for repeated miscarriages. A study from the Hospital de Clinicas Caracas in Venezuela looked at 65 women who received Glucophage during their pregnancies vs. 31 who did not. The early pregnancy (first trimester) loss rate in the metformin group was 8.8% as compared to a 41.9% loss in the untreated group. Of those women who previously had miscarried, 11.1% of the metformin group miscarried again, while 58.3% of the untreated group again miscarried.

REDUCED RISK OF GESTATIONAL DIABETES

 In another study at Jewish Hospital in Cincinatti, gestational diabetes risk was evaluated in two groups of PCOS women. The first group was 33 non-diabletic women who had conceived while taking metformin or took it during their pregnancy. This group was compared to a group of 39 PCOS women who did not take it. Only 3% of the metformin group developed gestational diabetes as compared to 31% in the non-metformin group.

WEIGHT LOSS AND OTHER BENEFITS

Metformin may contribute to weight loss in some diabetics. However, weight loss does not appear to be one of its primary benefits. Glucophage may also be of some value improving success with in vitro fertilization, lowering cholesterol, and improving energy.

The *DREADED* Side Effects of Metformin

 Here is a list of the “potential” side-effects of Metformin:

MALAISE

(10%- 25%)

 10%- 25% of women who take Glucophage just don’t feel well. They experience a general malaise, fatigue and occasional achiness that lasts for varying lengths of time. Malaise a signal for the physician to closely monitor body systems affected by metformin, including liver, kidneys, and GI tract. A blood count should be taken from time to time, because metformin can induce B vitamin insufficiencies that can lead to a form of anemia.

GI DISTURBANCE

(33%)

 About one third of women on metformin experience gastrointestinal disturbances, including nausea, occasional vomiting and loose, more frequent bowel movements, or diarrhea. This problem occurs more often after meals rich in fats or sugars. The symptoms lessen over time, so if you can tolerate the GI upset for a few weeks, it may go away. Some women have found it helps to start with a very low dose and gradually increase it. One “benefit” of these unpleasant symptoms is that you find yourself eating less and thus losing some weight.

(I can be a witness to this- this is no fun.  Day 1 and already miserable..and all I ate was some wings (not fried by the way) so I thought it shouldn’t be that bad…let’s just say I have nothing left in me and feel like I am swimming in nowhere land right now)

VITAMIN B12 MALABSORPTION

(10%-30%)

 Of patients who take this drug, 10%-30% show evidence of reduced vitamin B12 absorption. A substance formed in the stomach called “intrinsic factor” combines with B12 so that it can be transferred into the blood. Metformin interferes with the ability of your cells to absorb this intrinsic factor-vitamin B12 complex.

Over the long term, vitamin B12 insufficiency is a significant health risk. B12 is essential to the proper growth and function of every cell in your body. It’s required for synthesis of DNA and for many crucial biochemical functions. There is also a link between B12 insufficiency and cardiovascular disease.

At least one study raises the concern that even if metformin is withdrawn, the vitamin B12 malabsorption may continue in some people. The apparent cause is continued problems with availability of intrinsic factor, which is required for B12 absorption.

ELEVATED HOMOCYSTEINE

People who take Glucophage tend to have higher homocysteine levels.

Women with PCOS also tend to have elevated homocysteine. (I know- we can’t win!)

Homocysteine is an amino acid in the blood. A normal amount is OK. But an elevated level means that your metabolic processes are not working properly. Elevated homocysteine is associated with coronary artery disease, heart attack, chronic fatigue, fibromyalgia,cognitive impairment, and cervical cancer.

Vitamin B12, along with vitamin B6 and folic acid (another B vitamin), is responsible for metabolizing homocysteine into less potentially harmful substances . Therefore, when metformin reduces absorption of vitamin B12, you lose one of the nutrients needed to reduce homocysteine and thus reduce your risk of cardiovascular disease.

ELEVATED HOMOCYSTEINE & PREGNANCY COMPLICATIONS

(Yet this is suppose to help with miscarriage, right??)

Pre-eclampsia is a complication of pregnancy characterized by increasing blood pressure and edema. If left untreated, pre-ecampsia can lead to eclampsia, a serious condition that puts you and your baby at risk. In a study conducted at the Center for Perinatal Studies at Swedish Medical Center in Seattle, a second trimester elevation of homocysteine was associated with a 3.2 fold increased risk of pre-eclampsia.

The Dept. of Obstetrics and Gynecology, Nijmegen, The Netherlands, reviewed a series of studies on the linkage between elevated homocysteine and early pregnancy loss. They concluded that high homocysteine levels are a risk factor for recurrent early pregnancy loss.

Ovarian follicular fluid contains detectable amounts of homocysteine along with B12, B6, and folic acid. The follicular fluid provides nourishment to the egg by facilitating transport of nutrients from blood plasma. High levels of homocysteine as well as an insufficiency of B vitamins may adversely influence the process of fertilization and early fetal development.

NOTE: We are suggesting that elevated homocysteine, not metformin itself, could contribute to pregnancy complications in some women. However, metformin does contribute to increased homocysteine levels.

PREGNANCY WARNING

 Many women use metformin in their pursuit of a successful pregnancy. However, Glucophage is a category B drug, meaning its safety for use while pregnant has not been established. It is found in breast milk so it’s not advisable to breast feed while taking Glucophage.

ANEMIA

 By preventing optimal absorption of vitamins B12 and folic acid, metformin could induce or contribute to megaloblastic anemia. Megaloblastic anemia occurs when your bone marrow doesn’t have enough B vitamins to manufacture red blood cells. Your bone marrow then releases immature and dysfunctional red blood cells into circulation.

Although anemia is not common among people taking metformin, it remains a risk for those whose B12 and folic acid levels were already low when metformin therapy was started.

LIVER OR KIDNEY PROBLEMS

If you have liver or kidney problems of any kind, metformin could pose a problem, because it alters liver function and is excreted through the kidneys. A healthy liver and kidneys will improve your outcome with metformin. Liver and kidney function should be assessed before starting metformin and rechecked at least once a year while taking it. A blood chemistry screen and a complete blood count will tell your physician how well your system is doing with this drug.

MULTIPLE MEDICATIONS

You may be at risk for health problems or symptoms if you take metformin in addition to other medications. The more drugs you take, and the higher the dosage, the greater the probability there will be some kind of interaction between the drugs or some unexpected effect from the combined drugs. The effect of combined drugs also depends on the state of your health, your genetic uniqueness, and your diet and lifestyle. Always consult with your doctor if you add or change any medication, or if you develop any symptoms.

HAIR LOSS

 Metformin may contribute to male pattern hair loss at the temples and top of head. Although there’s nothing in the medical literature to support this linkage, some women have reported that hair loss was made worse by metformin.

 

****LACTIC ACIDOSIS****

(3 of every 100,000)

About 3 of every 100,000 people who take metformin will develop a medical emergency called “lactic acidosis”. Lactic acid is a metabolic byproduct that can become toxic if it builds up faster than it is neutralized. Lactic acidosis is most likely to occur in people who with diabetes, kidney or liver disease, multiple medications, dehydration, or severe chronic stress.

Lactic acidosis can gradually build up. Symptoms to watch for include a need to breathe deeply and more rapidly, a slow, irregular pulse, a feeling of weakness, muscle pain, sleepiness, and a sense of feeling very sick. Treatment requires intravenous administration of sodium bicarbonate. Contact your doctor or go immediately to a hospital emergency room if you have these symptoms.

BILE ABNORMALITIES

 Bile is produced by the liver, stored in the gallbladder, and secreted into the intestines in order to absorb fats into the bloodstream. One possible reason for the GI problems is that metformin reduces normal reabsorption of bile from the intestines back into the bloodstream, which causes elevated bile salt concentrations in the colon. Most studies suggest that colonic bile salts cause free radical damage to DNA and may contribute to colon cancer.

In addition, bile acids may stimulate cells in the colon to produce leukotriene B4 (LTB4), a highly inflammatory substance. LTB4 would be a contributor to any intestinal inflammatory condition. Byproducts of bacterial action on bile salts may lead to intestinal cell damage and absorption of “foreign” molecules such as food or bacteria particles into the bloodsteam, possibly causing allergies and other immune responses.

Moreover, many PCOS women have switched to a high-protein diet. If that protein consists of beef and other meats, bile acid concentration in the intestines is increased. A diet high in meats is also linked to a higher risk of colon cancer.

REMEMEBER TO CONSULT WITH YOUR PHYSICIAN TO MINIMIZE RISK!

Your physician should always do a thorough medical history and metabolic assessment before putting you on metformin. You should be re-checked at least once a year for as long as you take this drug. Make sure to ask your physician what the unique benefits and risks of metformin will be for you. If you doctor prescribes Glucophage without a careful review of your health status and without involving you in the decision, find another doctor.

Please comment with any other symptoms you have or similarities!!!! 

Polycystic Ovaries

 

Polycystic is a term that simply means “many cysts.” The polycystic ovary typically contains many small – usually less than 1 centimeter – cysts (fluid-filled sacs). These cysts are usually arranged around the surface of the ovary, just below the surface layer of the ovary. When examined directly or by ultrasound, these small cysts commonly are said to have a string-of-pearls appearance. The ovaries of affected women can be slightly enlarged when compared to unaffected ovaries.  

Each small cyst represents a follicle, which contains a single egg or ovum that is attempting to develop to a stage where it will be ready to be released from the ovary (a process known as ovulation). However, because of the complex biochemical situation that exists in ovaries with PCOS, the development of these follicles is stopped too soon, resulting in a collection of small follicles and the lack of ovulation. This lack of ovulation is the reason why women with PCOS commonly have difficulty becoming pregnant.

Not all women who are found to have polycystic-appearing ovaries on ultrasound have PCOS. Keep in mind, the polycystic ovary is a structural finding of the ovary, and this single finding should not be confused with the entire syndrome. In fact, many women who show no other signs or symptoms of PCOS have been found to have polycystic-appearing ovaries on ultrasound.

Many women hear the term “polycystic ovary” and associate this with ovarian cancer. This is not the case. Polycystic ovaries are not cancer, and a diagnosis of PCOS does not mean that you have cancer. Also, having been told you have had or currently have an ovarian cyst does not mean you have PCOS. Remember, the normal ovary creates a cyst every month through the process of ovulation. The presence or history of an ovarian cyst does not make for PCOS.

PCOS Quiz

This quiz is intended for educational and informational purposes only. In no way should this information be used as a substitute for medical advice, and I strongly recommend discussing this information with a qualified personal physician.

Instructions: 

Add the points up beside the symptoms you have.

Section 1: Menstrual Irregularities

Eight or fewer periods per year  +1

No periods for an extended period of time (4 or more months)  +1

Irregular bleeding that starts and stops intermittently  +1

Fertility problems  +1 (If you have been to a specialist, add another point)

Section 2: Skin Problems

Adult acne, or severe adolescent acne  +1

Excess facial or body hair, especially upper lip, chin, neck, chest and/or abdomen  +1

Skin tags  +1

Balding or thinning hair  +1

Dark or discolored patches of skin on your neck, groin, under arms or in skin folds +2

Section 3: Weight and Insulin-Based Problems

Sudden unexplained weight gain +1

Excess weight or difficulty maintaining weight +1 (Add another if it is around your middle)

Shaking, lack of concentration, uncontrollable hunger and/or mood swings 2 or more hours after a meal  +1

Family history of Type II Diabetes, Heart Disease or Hypertension +1

Type II Diabetes +2

Section 4: Related Problems

Migraines + 1/2

Depression and/or anxiety  + 1/2

Rapid pulse and/or irregular heartbeat  + 1/2

Pregnancy complications such as gestational diabetes or excess amniotic fluid  + 1/2

Results:

0 – 4 points-> You probably don’t have it.
Although PCOS is possible, it is much less likely for you than for those scoring higher.

5 – 9 points-> You could have it or another disorder.
If you are concerned about your health and score in this range, you may want to consider talking to your doctor about the possibility of PCOS, as well as other disorders.

10 – 15 points-> You probably have it.
PCOS is a syndrome, not a disease, and most women experience some but not all of the problems listed above. The majority of women who are diagnosed with PCOS score in this range. If you scored in this range you should see a doctor about the possibility that you have PCOS.

15 – 20 points-> See a doctor now.  It is very likely you have PCOS!
A score this high warrants urgent consultation with a doctor for PCOS or other endocrine-related disorders.

I personally score a 9/10 and have PCOS. 

Irregular or Non-existent Periods

 

PCOS:  The 2nd most common cause of irregular periods 

While the most common cause of irregular delayed menses is due to stress type hypothalamic amenorrhea, the next most frequent type is due to polycystic ovarian syndrome. This is a complex condition of the ovaries in which follicles seem to grow and produce estrogen but the egg does not get released. This results in a high estrogen condition but infrequent menses. When the period does start, it often can be a very heavy one that persists for days or even weeks. The continuous, high estrogens cause the uterine lining to grow and proliferate and eventually it gets too thick and then sloughs off causing a menstrual like bleed. Because of the chronic and continuous estrogen stimulation, most doctors feel that a menstrual period should be induced with hormones (progesterone/progestin) so that a woman is not at risk for endometrial cancer.

Description of Irregular Periods (Oligomenorrhea)

Irregular menses, as measured from the start of one menses to the start of another, seem to occur in two patterns:

• Onset of menses varies irregularly from about 3 weeks to 6 weeks but not skipping a month altogether. It is called metrorrhagia if many of the menses are less than 4 weeks.

• Onset of menses varies from 4 weeks to 3-6 months having perhaps only 2-6 menses a year. This is called oligomenorrhea, infrequent menses.

Oligomenorrhea, the infrequent, irregular menses pattern is caused by lack of ovulation. However, it may further be subdivided into a low estrogen type in which there are no follicles being developed and a high estrogen type in which the follicles are developed but they are arrested so none of the eggs are released (ovulated) from the ovary.

What are some other causes of irregular, more frequent menses?

Causes of the metrorrhagia irregular menses pattern are unknown or are more likely related to stresses and ingested medications or substances that disrupt corpus luteum function or even act as anticoagulant blood thinners. Caffeine may act this way and disrupt corpus luteum function. Heavy caffeine consumers tend to have twice the risk of short cycle length (less than 24 days). Their cycles are not heavier but they are often more frequent.

Cigarette smoking is another agent that can shorten menstrual cycles. Cigarettes seem to shorten the follicular phase but heavier smoking also may shorten the luteal phase. Both heavy smoking and even smoking just 10 cigarettes or more a day may cause menstrual cycles to be shorter in length, as well as more variable in their lengths than nonsmokers.

Acute or excessive alcohol ingestion, getting drunk on occasion, is also known to alter menstrual patterns . Sometimes it shortens cycles while at other times it can cause a delay of menses. The alcohol is thought to affect the liver’s ability to properly metabolize estrogen and progesterone.

What makes a woman not ovulate at all and have low estrogens?

There are many things that can block ovulation in women. Stress is the most common cause. Eating disorders such as bulimia and anorexia also cause low estrogen and menstrual delay. If there are no menses at all, this is called hypothalamic amenorrhea. The mechanism for this is not totally known but probably has to do with alteration of brain proteins and hormones so that the normal ovulatory releasing factors do not work. When the brain releasing factors do not stimulate follicle development, there are few estrogens produced and a woman is then at risk for osteoporosis at a young age. This is why physicians prescribe estrogens in this condition, i.e., to prevent bone loss.

Recreational running does not seem to change menstrual cycle length, but strenuous endurance running can disturb cycle length and make a woman anovulatory. Long distance runners and other strenuous sports have been well known to cause anovulation of the low estrogen type. There has even been a suggestion that being a vegetarian may increase the risk of anovulation.

 

What is the best non-prescription treatment to make menses more regular?

For a metrorrhagia type of irregular menstrual pattern, it is important to give up tobacco, alcohol and cut caffeine servings down to 2 or less per day. Try to minimize any medications that you do not have to take. If menses are mildly irregular and you are trying to time conception, taking a phytoestrogen supplement on a daily basis may help stabilize the menstrual cycle length.

For a low estrogen, irregular menstrual problem, the key treatments are:

• stress reduction and/or relaxation techniques

• elimination of overly strenuous physical exercise

• eliminate any eating disorders such as purging, bulimia, or anorexia

• take supplemental, measured estrogens such as phytoestrogens in soy or clover products

• For a high estrogen irregular menses pattern such as that found in PCOS, weight reduction using a low carbohydrate diet is essential. Even a 10% weight loss will help restore normal menstrual patterns in obese women who are anovulatory.

  What are the best prescription treatments for menstrual irregularities?

Oral contraceptives (OCPs) are the most commonly used hormonal treatment for irregular menses. They do not correct the underlying problem that causes the irregularity but they will regulate the pattern very precisely to the same day of the week each cycle. In general, oral contraceptives are very safe and will not cause an alteration in the body even after taking for a very long time. Some women cannot take birth control pills, however, so other treatments are also used.

Women with irregular menses due to hypothalamic factors can take a sequential hormone regimen. In this regimen, estrogen is given each day and then progesterone is given for 10-14 days each month in order to induce a withdrawal bleed. This regimen will not protect against pregnancy should ovulation occur so if a pregnancy is desired, this may be the best regimen.

For polycystic ovarian syndrome most physicians will prescribe oral progestins or progesterone to take for 10 days every two months if there has not been a spontaneous menses. This is thought to protect against the development of endometrial cancer or hyperplasia from the long term elevation of estrogens.

Carbohydrate metabolism abnormalities are often successfully treated with a combination of diet and medications, and the menstrual irregularities may disappear. Metformin, a drug which reduces high insulin levels has been shown to make women with PCOS resume normal menses in almost 90% of cases. This is a dramatic breakthrough in treatment and one worth seeing your physician about if you have PCOS.

Hospitalizations for Personality Disorders

Ranking of Harmful Drugs for 16-59 year olds

Women’s Health

Pregnancy Symptoms: 2nd Trimester (Week 13-26)

• You gain weight.
• You can feel the fetus moving.
• The skin on your stomach stretches and may get dry. (Use lotion to lessen the chance of stretch marks.)
• Your breasts get bigger. It helps to wear a supportive bra.
• A small amount of thin fluid (called colostrum) may come out of your nipples.
• You may experience ongoing heartburn, indigestion, and constipation.
• You may get nosebleeds.
• Your feet, hands, ankles and face may swell (this is called edema).
• A dark line develops on your skin between your navel and your pubic area.
• A "mask" or darker area or pigmentation may develop on your face. (It disappears after the pregnancy ends.)
• You may begin to develop varicose veins. Varicose vein relief is available if you are suffering.

Pregnancy Symptoms: 1st Trimester (Week 1-12)

Your period stops or becomes very light.

You may feel nausea or queasiness. Some women vomit. ("Morning sickness" can happen any time of day — it may help to eat small meals throughout the day, snack on crackers or toast, or drink juice or lemonade.)

Your breasts swell and may be tender.

Your nipples and the area around the nipples (areola) get darker and broader.

You have to urinate more often.

You feel tired.

You may become constipated and have heartburn (Tums may help).

You may have headaches.

You experience mood swings — feel angry, sad, or happy for no reason.

Pregnancy Symptoms: 3rd Trimester (Week 27-40)

• You can see the fetus move from the outside.
• Your navel pushes out.
• You begin to get backaches.
• You begin to walk differently to accommodate the weight of the fetus.
• You experience painless "practice" contractions.
• You have shortness of breath.
• Finally, labor and delivery!

Prenatal Vitamins

1.   You need to have a healthy diet with your prenatal vitamins- vitamins alone aren't enough.

The goal of prenatal vitamins is to supplement your diet not to replace it. In fact, prenatal vitamins work better when you are eating a healthy diet that includes a variety of foods. There are also known deficiencies in prenatal vitamins, for example calcium. The levels of calcium in the average prenatal vitamin is 250 mg.

A pregnant woman needs about 1,200 – 1,500 mg of calcium daily to help her and the baby adequately grow.

2.  Not all prenatal vitamins are alike. 

Recent studies showed that out of 9 prescriptions vitamins only 3 actually released the amount of folate that they claimed to contain. This means that even though they really contained the folate the body didn't absorb it.

3. Prescription vitamins are not neccesarily better than non-prescription vitamins.

Not all vitamins are created equally and many vitamins that are available by prescription are also available over the counter. What is more important are the ingredients in the vitamins and how well they absorb into your body. Many times prescriptions are written so that the cost of the vitamins will be picked up by insurance companies.

When you're trying to decide which prenatal vitamin is right for you, talk to your doctor or midwife about their recommendations and keep some things in mind:

• No prenatal vitamin will contain all of the calcium you need.
• Too much vitamin A can cause birth defects, be sure that you're using a prenatal vitamin or a multi-vitamin with under 10,000 IU.
• Too much iron in a prenatal vitamin will not be absorbed properly.
• The taste and texture of vitamins do bother some women. If you can't keep your prenatal down, consider switching brands.

I was told by my OBGYN that you need to start taking these 3-4 months before you get pregnancy so the Folic Acid can build up in your body.  This helps prevent against birth defects.  To keep from having stomach problems, she advised me to take these at night with a couple of crackers.

Pelvic Pain: Q & A Forum

Please Help my Daughter
I have a 13 year old daughter who started her menstrual cycle last year. She has already undergone a D&C but without a scope. Since then her heavy bleeding and pain has continued. She has been placed her on OVcon-50 birth control pills. The bleeding is now under control, but for the past 3 months the day she starts or the day before, she is in excruciating pain to the point that she vomits. I don't know what else to do, she has been to the doctor so many times she almost hates the fact that she is a female all together now. Can you tell me anything to do for the next step?

Answer:
I would certainly defer to the physician caring for your daughter. You may want to ask if the pill might be switched to a lower dose formulation over time, since 50 microgram pills can be associated with increased side effects. As far as an explanation for the pain, that is something that also best comes from her own doctor. There are many reasons why there can be significant pain associated with the beginning of a period in a teenager, and additional consultation from a pediatric/adolescent gynecologist may be helpful in some cases.

Vaginal Pain in a Teenager

I have a 14 year old daughter who has had 3 incidents of severe vaginal pain.  My wife states that her vaginal area becomes very inflamed.  It is so bad that she screams with pain every time she uses the bathroom.  Simply moving will cause her to burst into tears.  It appears that it occurs immediately after an illness such as the flu.  She has been to see her pediatrician on two of those occasions.  The first time she tested positive for vaginal strep and negative for genital herpes.  On her second visit the Dr. indicated that she believes our daughter has genital herpes.  We are still waiting for the test results; however, my daughter has come to me several times, very upset, and indicated that she has not had any sexual partners.  Our Dr. simply feels that our daughter is not being truthful.  We have a very good relationship with our daughter, and I truly feel that she is being truthful.   Can anything else cause these problems?  Can genital herpes be passed by any other method?  She had the chicken pox vaccine, could there be any side effects from this?  Any help would be appreciated, Thank you.

Answer:
I think that it remains unclear what is going on, such as whether or not this is herpes, so I would defer to the clinical judgment of your daughter's doctor. In addition, consultation with a gynecologist, and even a pediatric/adolescent gynecologist, might be useful if the situation remains unclear. Please discuss this further with your daughter's physician.

Persistent Pain 

I am a 37 yr. old woman and have had a history of alcohol and narcotic use for ten years. I am now clean but have had persistent knife like pain on the right side half way down my back, I have all the appropriate tests and the results say I have a mal-rotation of the kidney and my ovary is enlarged with a cystic lesion. What can be done for this; it is has been 7 months and the pain is worse. Please help me, I cannot take the pain any longer.  I am also having a lot of frequent urination and releasing a lot of urine, which is very abnormal for me, I never even felt this during my 2 healthy pregnancies.

Answer:
Please consult your doctor as soon as possible to establish what the “cystic lesion” is on the ovary. It is important to determine if this should be managed by repeat ultrasound in a few weeks, or surgery. The plan of action requires more detailed knowledge of your ultrasound, and that is best managed by your own doctor.

 

David B. Toub, MD,
OBGYN.net Editorial Advisor Pelvic Pain, Laparoscopy and Hysteroscopy, Hysterectomy and Alternatives

Corpus Luteum Cysts: Q & A

Question:

I recently found out that I have "Corpus Lopus Cysts".  I think that is the way you spell it.  It hurts on my left side.  Can you tell me what it is, and what is usually done about it. 

Answer:  
I think you may be referring to corpus luteum cysts, which are normal occurrences due to ovulation. In general, they resolve on their own, but in some cases can bleed into the cyst itself and occasionally can require surgery. Most corpus luteum cysts do not require any treatment whatsoever, but should be followed up with ultrasound to make sure they have gone away. If persistent, it may be that this represents something other than benign corpus luteum cysts. Please discuss this further with your doctor, who can best provide individualized guidance on this matter. Good luck, and thank you for your e-mail!  

David Toub, M.D.

Hysterectomy Pain: Q & A

CPP Post Hysterectomy 

 I am 52 years old and had a hysterectomy in 1999 due to vaginal bleeding, my ovaries were not removed. Since the surgery I have suffered from some severe pelvic pain. In 2001 I had a laparoscopy to remove some adhesions.  The pain on the right side stopped but I still hurt on the left side and now the pain sometimes goes down my leg. My gynecologist did not see a problem and now I am seeing a gastroenterologist. Could please tell what to do?

Answer:  
I can’t tell you what to do—that is best handled by your doctors—but I can say that there are many possible reasons for pain in your situation. In any event, please discuss this with your doctor. You may want to ask your doctor if evaluation by a different specialist, in addition to the gastroenterologist, may be useful.

David Toub, M.D

Biopsy Results Appointment

Well, I guess there was good news and bad news.  The good news- the tumor that they thought was a hepatic adenoma is actually a focal nodular hyperplasia (a tumor like the hepatic adenoma, but they rarely ever rupture or cause symptoms, don't turn malignant, and aren't caused by birth control). 

 

So…..I am going back in 6 months to get another done to see if it has grown……but the bad news is that I asked why I was having the pain I have been having and the other symptoms if this is not causing it.. The doctor thinks I have an ulcer and gave me some prevacid to take for a month and then I got back to see if I need to have an endoscopy done.  Fun, fun, and more fun. I can't get lucky and just be "ok"….

Hepatocellular adenoma and polycystic ovary syndrome

Here is a smidget of an interesting article I found:

Hepatocellular adenoma and polycystic ovary syndrome

Christian Toso1, Laura Rubbia-Brandt2, Francesco Negro2,3, Philippe Morel1 and Gilles Mentha1

Abstract:
Various identified risk factors predispose to hepatocellular adenomas. We present the case of a young woman with liver adenoma in a context of polycystic ovary syndrome, associated with high levels of androgens and following a high dose hormonal therapy. In view of this complication, we recommend a close screening of patients with such hormonal imbalance, especially those who are treated with high doses of hormones, with repeated liver tests and ultrasonographies.

Sick of feeling sick

I feel like I am in a constant daze lately….almost like I am on drugs or something (but the bad part of being on medication, not the good). I still feel dehydrated constantly (drank a liter of water on the 15 minute drive to work today and it did not seem to help).  Took my temperature today- and I didn't have one…but I seem like I can never get my body temperature regulated any more…almost like I am having hot flashes (and no- I am way too young to have menopause).  I don't know if this is caused by my liver or what.  I mean…..no one said these symptoms could be caused by that or by the PCOS…but if not that, what could it be?  They checked for diabetes, thyroid, etc.  I don't know…I am just tired of feeling tired, thirsty, hot (and sometimes cold…but mostly hot), sick, and confused.  Any comments are *MORE* then welcome…

Biopsy Results

 

Well, after waiting a week for my results (after being told it would only take a couple of days) I called back and was told the "pathology" is negative.  I was like…ok…so that means it is not cancerous right?  The woman said yes.  Well, that wasn't a huge surprise because they had taken tumor counts (in blood tests) etc, so I didn't think it was cancerous to begin with.  Don't get me wrong- not that I wasn't glad to hear it..but the limited information I was given had me even more frustrated.  She then said that my doctor wanted me to do a catscan in another 6 months.  I was like…well I have an appointment Friday…so I guess we will discuss that then.  I was thinking, "So I get to wait 6 months and see if this tumor ruptures or not…oh fun".  Plus the fact I would like to get pregnant and getting pregnant with this thing is a big no no considering it would rapidly grow. 

Anyways…I said well, what kind is it (which I thought that was the main purpose of the biopsy) and she said it didn't say…  Well great…She said all that it said was that the cells showed inflammation.

So…I found out from that wonderful call that a- it is not cancerous, b-the cells have inflammation, and c-my doctor wants me to do another catscan in 6 months (I guess)….

I was more frustrated when I got off the phone then before the call. I guess all I can do is wait until my appointment Friday…

After the Biopsy…Pain, Pain, and More PAIN

 

All I could say is PAIN PAIN PAIN.  It seemed as soon as they were finish- the sedative was completely gone.  They needed me to get up to move from the CT table/operating table to the hospital bed and I tried for a quick second and then thought, are these people INSANE!!!!! They ended up having to put a board under me and lifting me up on the bed.  They then took me back to my "recovery" room…and all I could think of is, you have got to be kidding. No one ever told me that I would be in this much pain.  No one.  (Unless something catastrophic happens like puncturing a lung or something, which at this point I thought may have happened).  I could barely talk- the pain was inbearable to mumble above a whisper.  It hurt to breath- hurt to move- just hurt.  They came in every 15/30 minutes to check the wound site and my bloodpressure and pulse. They kept asking me if the pain was any better…and I kept saying no no no. 

 Before they would give me anything for the pain, they said they had to do a chest x-ray.  I thought, what in the hell does that have to do with giving me something for this unbearable pain I am having?  So, the woman came in to do the x-ray and then expected me to sit up.  Sit up?  SIT UP?  Once again I said- you have got to be kidding me.  She said hold my arm…which I did….but it is not like that actually made it feel any better.  I finally got up enough to where she could put the board behind my back and take the x-ray and thankfully was able to lie back down.  But still, no pain medication.  Almost 2 hours later, after my mother bugged the crap out of the nurse, she finally brought me a lortab (which the nurse said was "good stuff" and it should do the job). I was like…sure…why couldn't u have just inserted something in my IV so it would have worked right then?

But anyways….30 minutes or so after that it finally kicked in (but still didn't do much for the pain) and it was time for me to get up (I thought ha ha ha) and leave.  Note- this was after 4 hours of bedrest.  4 hours and I still had no desire what-so-ever to get up.  I would have happily stayed in that bed for the rest of the day and night.  But, I had to get up.  I went to the bathroom on my own (happy happy joy joy) and when I was coming back out I felt dizzy…not just a little dizzy…like I was going to faint.  And faint I almost did.  Everyone said all the color drained out of my face, I started sweating and layed back down.  The nurses came back in and checked my blood pressure, which was ok and I waited for a while and then tried to get up again with a little better success this time. 

After checkout, I went home and went straight to bed.  I stayed in bed the entire evening other than going to the bathroom.  I called off from work for the next day and stayed in bed most of that day too.  It still hurt to laugh and move, but at least breathing wasn't quite so painful.  Two days later, I am back to work (begrudingly at that) and am still in pain, but at least it is now bearable.  I did park in the handicap space though, and would love someone to say something about it.  There was no way I was walking across this entire parking lot. 

My stomach has been in pain ever since the biopsy and is very tender to the touch.  I have had horrible bouts of diarrhea (yeah, I know, not a great topic to read about…) and am wonder, what is going on?  I didn't read anything about that being one of the symptoms, but then again…..most things didn't seem to go as in the "textbook" either. If anyone else has been through this, comments are more than welcome….hopefully it will pass in a few days, but I am just worried that someone might have gotten "messed up" in the process….. 

The Liver Biopsy

 

After all the initial crap, I finally got put in the room to have my biopsy.  I had three men hooking up EKG pads to me (I wondered why there needed to be three of them…but hey) and then they told me that they were going to be giving me a sedative and if I wanted to take short naps I could.  I took goody..because if I wasn't going to at least get some kind of drugs out of this then I was going to be pissed royally.

 

I was told by the doctor beforehand this was going to take approximately 45 minutes (even though i read that it takes 10 or less in about a million articles).  He said they would be doing catscans to make sure that they were putting the needle in the right spot and that they did not puncture a lung (I had to breath in while they were doing it).  Once they gave me the sedation, I felt pretty good I must say.  There was a dull pain when he was inserting the needle, but they had me on some pretty good stuff. Then comes after the biopsy…

 (This is what the liver biopsy normally looks like,

though mine was done in the middle of my chest instead)

(Picture of Tissue Drawn)

Before my Liver Biopsy

 

I went in to the hospital Monday to have my liver biopsy.  I arrived at 8 AM (as directed) and they gave me a pager…well it went off about 10 minutes later…and then I had to go into one of those little rooms to talk about $$.  I was told my insurance covers everything BUT $450……and that they needed 25% down to start this procedure.  I was like…ok…I was never told that??? And she said- well you should have been.  (From the woman's attitude it seemed like it was her that was about to have a biopsy done….) So anyways..she went upstairs and got it approved for me to set up payment plans (like I can really afford that…but anyways). 

I was then instructed to go through another door and that woman gave me yet another pager..I waited for a little while longer, and then gave the pager to my mother (whom I begged not to come, but that is a story for another day).  I took my hubby (or domestic partner if you want to be picky about it) back with me and then had blood drawn.  I thought, Haven't they drawn enough blood in the past week as it is???? Then, I went to yet ANOTHER woman who asked about 5 million questions.  Luckily, she was very nice so it wasn't so bad..if you don't mind talking about your BM (bowel movements)- which she finally decided to put in the computer as "irregular" and any other problem you could have ever had in the past.  One of the questions-LMAO- was "have you ever had liver disease"- hahaha- ummm…yes, I have a liver mass and am here to have a liver biopsy…but anyways…

They took me to yet another room and a nurse came in and hooked an IV up to me and gave me water. (Thank goodness- I was parched after not being allowed to eat or drink for 8 hours+ the 2 hours it had already taken to get that far!) She took my temperature, which was 100 and asked me if I had been running a fever- I said no, and I don't feel hot.  She said, Well, you are probably just dehydrated.  I thought yeah…..30 minutes without something to drink and I am dehydrated. After we waited there for about 30 minutes, the "transporter" came to get me (I felt like I was in starwars) and I guess her job was not too exciting because she asked me a few questions and then said I was "just a baby" and that she was 40.  I thought 40- wow- so old. (Note my sarcasm). 

 

So, she left me in this waiting area…if you want to call it that…it was in the middle of the hallway with a linens "closet" and some curtains that werent closed.  That took about another hour.  The nurses kept coming to tell me that they hadn't forgot about me and that the doctor was just a little slow..and then that they needed my catscans and asked why I was getting a liver biopsy. I thought…hmmmmm…should they not have already LOOKED at my catscans?  Oh the confidence I felt then….And the doctor then asked me the same thing, and why are we doing this liver biopsy today?  Great….But I did see the humor in his braces and lisp…

Memory Processing

 

Memory, an essential part of life and independence, is primarily stored in the cerebral cortex. The inferior temporal cortex stores visual memory; whereas, the frontal cortex stores associations. New declarative memories, involving facts and events, are formed in the hippocampus and related structures in the medial temporal lobe (memory). The entorhinal cortex supplies the majority of the information that is sent to the hippocampus (Carson, 2004, 416). Some researchers believe that the hippocampus is similar to a temporary holding cell and memories slowly seep into the permanent storage area of the cerebral cortex. This process could be compared to an inbox; once the inbox is full, items are archived into a different area. On the other hand, the majority of researchers believe that the hippocampus does not store information, but instead is needed to help create new memories (memory). Carson agrees with the latter, and that the hippocampus inputs information from the sensory and motor cortex, processes the information, modifies the memories, and links them together in ways that can be more easily remembered (Carson, 2004, 416).

The amygdala plays a vital role in memories of an emotional nature. Someone with amygdala damage may be able to remember details of an event, but will forget emotional information (memory). The right prefrontal and bilateral hippocampal gyrus, which surrounds the hippocampus, is associated with visual (picture) memory; while word associations are connected to the left prefrontal and left hippocampus gyrus. The left hemisphere of our brains is responsible for encoding memories, and the right hemisphere is in charge of retrieving memories. Medial temporal and midline diencephalic processing, composed of the thalamus and hypothalamus, control the consolidation of memories; which, as a result, enables long-term memory processes to occur (neuro). Bilateral anterior lesions on the thalamus can cause permanent amnesia, while posterior lesions do not normally cause a noteworthy problem. The severity of anterior thalamus damage can affect both hippocamal and perirhinal pathways (because of the location); and in turn, disrupt the “transmittal” of memory from one area to another. For example, one well known case involves a man that has had amnesia since 1960 due to a brain injury. The patient’s verbal memory was destroyed, but he has no problem with other cognitive functions. Even as far back as 1988, researchers were able to produce evidence that lesions in the dorsomedial nuclei and the hippocampal tracts cause a memory disorder. The location and extent of the lesions determined the severity of the memory deficit. Accordingly, left-sided lesions produce verbal memory loss, while right-sided lesions produce memory loss of a visual nature (Ringholz, 2000).

The caudate nucleus, located in the lateral ventricle of the brain, regulates the organization and priority of information sent to the frontal lobes. Individuals with Huntingdon Disease often have many memory difficulties due to damage of the connection between this region and the frontal lobes. Unlike patients with Alzheimer’s disease, patients with HD cannot learn or recall motor memories; so, their speech is often slurred, stuttering is common, and body movements are also uncontrollable. They can recall memories, but not find the right words to express them. Also, they can remember experiences when given choices to pick from and benefit from cues- exactly the opposite of patients with Alzheimer’s disease. Without organization, memories only matter so much. Memory problems in HD can be compared to reading a book where the pages or words in a sentence are all out of order. Everything is there, but it still does not make any sense. Even though these individuals can understand what someone is saying, response time is extremely slow due to the brain’s “search mechanism” being damaged. Actions that were almost “unconscious” at one point, such as driving or walking, will now become very difficult because intense concentration will be required (Stanford). Memory, unlike many of the brain’s functions, is something that most people (especially students) think of from time to time. Not being able to recall someone’s name or an important piece of information can be very embarrassing or frustrating, to say the least. Damage to areas such as the hippocampus, amygdala, thalamus, and caudate nucleus can cause memory problems. Memory is so complex that memory loss is actually “specialized”. Some people may have trouble with short-term memory, while other people have trouble with long-term memory. The organization of memories or even creating new memories may be impossible. My memory is not “the best”, but I feel fortunate that I can at least put sentences together, remember what I ate last, and recall vital information. Without these traits, life would be much more difficult and confusing. References: Cognitive Symptoms X1. (2004). HOPES. Retrieved February 15, 2006 from http://www.stanford.edu/group/hopes/diagnsis/cognitiv/x1.html Long, C.J. (n.d.). Memory. Retrieved February 12, 2006 from http://neuro.psyc.memphis.edu/NeuroPsyc/np-ugp-memory.htm Myers, Catherine. (2005). Memory. Memory Loss and the Brain. Retrieved February 12, 2006 from http://www.memorylossonline.com/glossary/memory.html Ringholz, George. (2000). Summary and Discussion: Patient #44. Baylor Neurology Case of the Month. Retrieved February 15, 2006 from http://www.bcm.edu/neurology/challeng/pat44/summary.html.

Animal Research: Positives and Negatives

 

Animal research is a controversial issue. One can not deny that there are many benefits, but also some drawbacks associated with this research. Animal research has accomplished many significant findings, including, but not limited to: modes of adaptation to change, cures for many diseases, and coping with psychological disorders and drug addiction. Studies even help further the animal kingdom by keeping animal populations from going extinct.

Even so, animal activists and the much of the general public would happily comment on the disadvantages of this type of research. The most common concern is the ethical dilemma in researching animals, which often includes operating and eventually putting these creatures to sleep. Psychologists use techniques such as administering anesthesia, pain medication, and antibiotics along with keeping animals in clean conditions to give these creatures the most humane treatment possible during research. Another concern is that animal laboratories are very expensive and difficult to maintain.

Scientists did not begin experimenting with animals, but in my opinion, the end is no where to be seen. I can not see a time when animal research will not be needed. Computers only function from data that humans input; we still have to get that data from some source. Even plants and tissues, which have purpose in some experiments, can not help in the behavioral field of study. Animals must be used to save lives.

Neurotransmitters with an emphasis on opioids

 

The major types of neurotransmitters in the brain are dopamine, norepinephrine, and serotonin, which are catecholamines; glutamate, GABA, and glycine, which are amino acids; peptide neurotransmitters called opioids; a nucleoside called adenosine; a soluble gas called nitric oxide; and acetylcholine, the primary neurotransmitter .

Catecholamines, a subcategory of monoamines, increase or decrease the activities of certain brain functions. Norepinephrine, dopamine, and serotonin make up the catecholamine chemical family. Dopamine helps us to learn, move, and keep our attention on something. Norepinephrine (what we commonly call adrenalin or epinephrine) produces excitatory behavioral effects. Serotonin regulates mood, sleep, pain, and arousal, among other things (Carlson, 2004, 116-122).
Amino acids are used for protein synthesis. The three most common amino acid neurotransmitters are glutamate, gamma-aminobutyric acid (GABA), and glycine. Glutamate is believed to be the first neurotransmitter, on top of being the principal neurotransmitter in the brain and spinal cord. It modifies the threshold of excitation. GABA is produced from glutamic acid and is an inhibitory neurotransmitter in the brain. Glycine serves as an inhibitory neurotransmitter in the lower area of the brain and the spinal cord (Carlson, 2004, 123-126).

Adenosine, a combination of ribose and adenine, is a nucleoside compound. When cells are short on fuel, it is released. This release activates receptors of blood vessels causing them to dilate and increasing blood flow. Nitric oxide receives the most attention out of all the soluble gases and is used as a messenger in many parts of the body. The primary neurotransmitter secreted by axons of the central nervous system, acetylcholine, is responsible for all muscular movement (Carlson, 2004, 113-128).

Finally, I am going to discuss the effect of opioids, a popular peptide. Peptides consist of two or more amino acids that are linked together. Three types of opioid peptides exist (enkephalins, endorphins, and dynorphins). All three reside in the pituitary and adrenal glands, but they are released into circulation and can be found in many organs.
Opioid peptides modify the actions of other neurotransmitters in the central nervous system (CNS). They make the neurons more difficult to excite and can provide pain relief and euphoria along with various behaviors. Opioids are very distinctive because they regulate major neurotransmitters including acetylcholine, dopamine, norepinephrine, serotonin, and gamma aminobutyric acid (Froehlich, 1997).

Alcohol can activate opioids, which explains some people’s disposition to alcohol addiction. These peptides yield the same effects as morphine and heroin (hence the similar name of opioid and opiate). Mediating pain perception, emotional responses, and cardiovascular or respiratory functions are only a few of the functions opioids alter. To produce the aforementioned effects, opioids bind to receptors on the cell surface. Once this is accomplished, the biochemical effects occur. Alterations to the endogenous opioids can enhance the conditions of obesity, depression, diabetes, and epilepsy, along with alcoholism (as previously mentioned) (Froehlich, 1997).

References:
Carlson, Neil R. (2004). Neurotransmitters and Neuromodulators. In Physiology of Behavior, 8, 112-130.
Froehlich, Janice. (1997). Opioid Peptides [Electronic version]. Alcohol Health & Research World, 21, 132-135.

Neuroanatomical Structure: Solitary Tract

 

The solitary tract is “a slender compact bundle of primary sensory fibers that accompany the vagus, glossopharyngeal, and facial nerves and convey information from stretch receptors and chemoreceptors in the walls of the cardiovascular, respiratory, and intestinal tracts and impulses generated by the receptor cells of the taste buds in the tongue” (answers). In simpler terms, this structure is a group of fibers that interact with three cranial nerves responsible for controlling sensations and motor functions. Together, they send information from receptors in the walls of the heart, lung, or intestines that respond when tissues stretch or chemicals react; taste bud receptors also transmit signals in this way.

When researching the aforementioned formation, one will find the most information on the nucleus of the solitary tract, or NST for short. The NST is a cell column that is located in the back part of the medulla oblongata (the structure that controls respiration and circulation). It serves as the sensory nucleus of the brainstem and obtains fibers that send impulses to a nerve center in the brain. These axons that conduct nerve impulses come from the vagus, glossopharyngeal, and facial nerves (as discussed above) by way of the solitary tract (medical-dictionary).

Though not as widely discussed or understood as other neuroanatomical structures, the NSF plays an important role in living organisms. Serving as a “hub” for messages is an essential function of this nucleus. Once taste information is received from cranial nerves, the NSF passes the message to the thalamus. The thalamus then does its job of relaying the message to the cerebral cortex, an area responsible for higher brain function. The limbic system, which contains the hypothalamus(1) and amygdala(2), controls many involuntary functions and is an additional recipient of the information (faculty).

Extensive research has been done on how neurotransmitters interact with the NFS. Glutamate, an excitatory amino acid, is believed to be one of the neurotransmitters that enables communication between the vagal nerve and the NSF. Noradrenergic neurons located in the NSF exist to release norepinephrine(3) in the amygdala and are excited by the amino acid. This excitatory action may very well be the means by which signals sent by the vagus nerve adjust methods of storing new experiences in memory. Experiments have been conducted on rats to prove this point. When NTS neurons were activated with glutamate, memory associations were much stronger; in this case, the association was between drinking water and footshock (Miyashita 2002). The bed nucleus of the stria terminalis (BST)(4)also receives taste information and sends this info to the NFS. Neurons of the NFS that were responsive to sucrose, NaCl, citric acid, and quinine hydrochloride were also affected by BST (Smith, Ye, Li, 2005).

Damage to the NFS can appear in lesions. Unsurprisingly, experiments suggest that rats with lesions on the nucleus can not taste, though scientists can not prove this fact. The rats may in fact be able to taste, but no longer experience pleasure through eating. Whether the rats can in deed taste or not, few can survive with large lesions of the NST. Little evidence has been discovered connecting ingestive behavior to the NFS, yet it is suggested that this structure may play a part in the process, and that the lesions can be disruptive to the every-day process (Shimura 1997).

A study conducted on individuals who died due to acute heart failure caused by ischemia (restriction in blood supply) produced noteworthy findings. Lesions were discovered on the patients’ NFS. This report will seem strange if one only thinks of the NFS as a hub for taste stimuli. One must bear in mind that the nucleus of the solitary tract also functions as one of the nuclei in the medulla responsible for monitoring of respiratory and cardiovascular functions, even though it is not elaborated on in this discussion. All other medullary and pontine nuclei were lesion-free. This suggests that the neurons of the NSF have a special vulnerability. Also, it is believed that these lesions may prevent the patients from recovering by stopping independent cardiac and respiratory functions, even when life-saving procedures are administered (stroke).
In conclusion, the solitary tract is a complicated, but important neuroanatomical structure of our brain. More experiments are sure to follow and hopefully one day we will have a better understanding of how the solitary tract functions. Until then, just be thankful every time you taste that juicy steak or an ice cold drink.

Footnotes:

1.
The part of the brain that lies below the thalamus, forming the major portion of the ventral region of the diencephalon and functioning to regulate bodily temperature, certain metabolic processes, and other autonomic activities (answer).

2.An almond-shaped mass of gray matter in the anterior portion of the temporal lobe. Also called amygdaloid nucleus (answer).

3. A substance, C8H11NO3, both a hormone and neurotransmitter, secreted by the adrenal medulla and the nerve endings of the sympathetic nervous system to cause vasoconstriction and increases in heart rate, blood pressure, and the sugar level of the blood (answer).

4. The Stria Terminalis is a forebrain structure that participates in anxiety and stress responses (answer).

References:

1. http://faculty.washington.edu/chudler/tasty.html

2. http://medical-dictionary.thefreedictionary.com/nucleus+of+solitary+tract. (2004).

3. http://stroke.ahajournals.org/cgi/content/full/31/5/1187. (2000).

4. http://www.answers.com/. 2006.

5. Miyashita, T. & Williams, C. (2002) Glutamtergic Transmission in the Nucleus of the Solitary Tract Modulates Memory Through Influences on Amygdala Noradrenergic Systems[Electronic Version]. Behavioral Neuroscience, Vol. 116, Issue 1.

6. Shimura, T, Grigson, P., & Norgren, R. (1997) Brainstem Lesions and Gustatory Function: I. The Role of the Nucleus of the Solitary Tract During a Brief Intake Test in Rats[Electronic version]. Behavioral Neuroscrience, Vol. 111, Issue 1.

7. Smith, D., Ye, M., & Li, C. (2005) Medullary Taste Reponses are Modulated by the Bed Nucleus of the Stria Terminalis[Electronic version]. Chemical Senses. 421-424.

Correlation between Psychostimulants, Dopamine, & Amphetamine; Sexual behavior

An experiment was conducted at the University of British Columbia to examine the correlation of psychostimulants, dopamine, and sexual behavior. The hypothesis that “behavioral sensitization caused by repeated psychostimulant administration can ‘cross-sensitize’ to a natural behavior, such as sex, and that increased NAC[nucleus accumbens] DA[dopamine] release may contribute to the facilitation of appetitive and consummatory aspects of this behavior” was supported by results of the study (Fiorino 1999). Simply put, giving an organism a drug (like cocaine) over a period of time can cause the drug to have a stronger affect then it originally did, as referred to in the previous sentence as behavioral sensitization. Scientists set out to prove that behavioral sensitivity due to repetitive drug use can influence the sensitivity of other behaviors, and that increased dopamine release in the nucleus accumbens can account for an increase in the desire for gratification by way of sexual intercourse.

The researchers used several of the techniques discussed in Physiology of Behavior to prove their hypothesis. Male and female rats were kept in separate plastic cages when they were not being observed. The ovaries of the female rats were removed, and they were given estradil benzoate (the most powerful hormone secreted by the ovaries) and progesterone (produced by the body to prepare for implantation) (Fiorino 1999).

Stereotaxic surgery, which is most often used for lesion production, was performed on the male rats. In this case, the surgery was done so that the scientists could insert microdialysis probe guide cannulas into the NAC. The cannulas, or small metal tubes, function by carrying a solution into a certain area of the brain (in this case the NAC) so that it can collect molecules from the extracellular fluid; after the molecules are collected, the fluid comes out through another tube. The cannulas were secured to the skull with dental acrylic and jeweler’s screws, and a wire “training post” was cemented to the top of the skull behind the cannula (Carlson & Fiorino, 2004, 1999).

Chambers were used to join the male and female rates together. For twenty consecutive days, the male rats were placed into its appropriate chamber and attached to a liquid swivel by way of a steel coil that was secured to his training post. The rats waited half an hour before D-amphetamine sulfate or the saline control was administered, and two hours more after the injection was given. This way, the rats were able to get accustomed to the probe and their surroundings before testing began. Samples were taken by microdialysis every ten minutes during this two-hour period (Fiorino 1999).

All the male rats were sexually inexperienced, whereas the female rats were not. On the twenty-first day, the female and male rats were joined for sixty minutes, while interaction was allowed for thirty. Sexual behavior was videotaped and recorded by computers. Many statistics were available, including, but not limited to, ejaculation frequency and latency, mount frequency, and intromission (insertion) frequency. Microdialysis was used to determine the amount and alterations of dopamine in the NAC (Fiorino 1999).

After the test was completed, the mice were given a fatal dose of chloral hydrate and underwent perfusion via saline and formalin injection (used to harden the brain). The brains were sliced and sections were stained with cresyl violet to determine if the probes were placed in NAC. Only the mice with correct placement of the probes were included in the study (Fiorino 1999).

Stereotaxic surgery was used to pinpoint the correct area of the brain for probe insertion. Histological methods (such as fixation, sectioning, and staining) were used to ensure the results were valid by verifying what area of the brain was tested. Microdialysis was used to view the extracellular changes, along with video and computer monitoring of physical activity. All these techniques were used to ensure the validity of the test, to make the relationship between psychological and physical functions clear, and to have a deeper understanding then the naked eye can provide (Carlson & Fiorino, 2004, 1999).

In conclusion, the results confirmed that the male rats who were given D-amphetamine displayed a much higher dopamine increase during the first thirty minutes of female-exposure opposed to the control group. They also had an increased number of mounts, ejaculations, and intromissions. A higher dopamine increase occurred for two-hours after drug injection opposed to normal readings, and a noteworthy increase occurred between the first and tenth injection. Scientists can conclude from this study that using a drug over a period of time can cause an increase in the amount of dopamine release, which in turn raises an organism’s sexual drive and triggers behavioral sensitivity (Fiorino 1999). .

References:
1. Carlson, Neil R. (2004). Neurotransmitters and Neuromodulators. In Physiology of Behavior, 8, 112-130.
2. Fiorino, D. & Phillips, A. (1999). Facilitation of Sexual Behavior and Enhanced Dopamine Efflux in the Nucleus Accumbens of Male Rats after D-Amphetamine-Induced Behavioral Sensitization [electronic media]. The Journal of Neuroscience, 19(1), 456-463.

Concordance Study of Bipolar I Disorder in Twins

 

Studying the concordance, which is the similarity of certain characteristics, in twins is a popular method of determining the role of genetic effects in mental disorders (Carlson 2004). Consistent results in studies of twins with bipolar I disorder have supported the hypothesis that genetic factors are great contributors to mental disorders. Accordingly, a similar study was done using a population-based twin sample in which personal interviews were conducted to formulate diagnoses. This study was approved by the Ministry of Social Affairs and Health, along with the Ethics Committee of the National Public Health Institute (Kieseppä, Partonen, Haukka, Kaprio, & Lönnqvist 2004).

All Finish same-sex twins born between 1940 and 1957 were screened for a diagnosis of bipolar I disorder, either through surveys or in the National Hospital Discharge Register. Thirty-eight pairs were identified and invited to participate via mailed invitations; 68% (or 26 pairs) accepted. Participants had to be diagnosed with either bipolar I or the bipolar type of schizoaffective disorder; individuals with bipolar II disorders did not qualify. Five individuals included in the test were deceased (three due to suicide, one due to alcoholic withdrawal and acute mania, and one unknown); forensic examinations along with medical records and information from the opposite twin were utilized All available medical records were obtained prior to personal interviews. Clinical and demographic characteristics of participants in the study and outside of the study were compared using Fisher’s exact test, the chi-square test, Student’s t test, and the Mann-Whitney rank sum test. These tests helped to affirm that there was a representative population sample of twins (Kieseppä, et al. 2004).

Seven of the 26 pairs were monozygotic (identical) and 19 were dizygotic (fraternal). These statistics are also comparable with the national percentages. The study found that the concordance for bipolar I disorder in monozygotic twins was 43%, while only 6% for dizygotic twins. Once the participants with schizoaffective disorder were included, the percentage of concordant monozygotic twins went up to 50%, where as the dizygotic twins went down to 5%. Three-fourths of identical twins experienced concordance for the broad affective disorder spectrum, along with 11% of dizygotic twins. Zygosity testing was performed by means of autopsy tissue samples, microsatellite markers (used in routine paternity tests), and questionnaires on resemblance and confusability during childhood. Interviewers were unaware of the results while testing; the tests were done only after the final diagnoses. Concordance rates were then recalculated to include zygosity results. Two of six (33%) monozygotic twins and one of thirteen (8%) dizygotic twins were concordant for bipolar I disorder; whereas the concordance rates for bipolar I disorder plus schizoaffective disorder and bipolar type were three of seven (43%) and one of fourteen (7%), respectively (Kieseppä, et al. 2004).

Different models were used to account for other factors that could play a part in bipolar I concordance of twins. The E model, which was based strictly on specific environmental factors, was rejected by the chi-square test. The CE model used both common and specific environmental factors; even though it could not be completely rejected, it fit much worse than the ACE and AE models. The AE model, which was the best fit, included both genetic and specific environmental factors. Environmental risk factors, including problems during pregnancy and delivery and childhood infections, were also ascertained from birth clinics, maternity clinics, and child welfare clinics. No significant differences in concordant or discordant pairs of twins were noted (Kieseppä, et al. 2004).

In summary, the results from this study supported past studies. Bipolar I disorder is slightly concordant in fraternal twins, and extremely concordant in identical twins. Concordance rates rise even farther when twin pairs consisting of one individual having bipolar I disorder and another having a disorder in the broad affective spectrum are included. Environmental factors do seem to a play a part in the concordance discussed above, but can not be the only cause. Problems during pregnancy or birth do not appear to have a significant influence on bipolar I concordance in twins. Though this study was small, it included a significant representation of the entire population and used evidence to support the hypothesis that genetics play a role in mental disorders, especially bipolar I disorder.
References:
1. Carlson, Neil R. (2004). Methods and Strategies of Research. In Physiology of Behavior, 8, 160.
2. Kieseppä, T., Partonen, T., Haukka, J., Kaprio, J. & Lönnqvist, J. (2004). High Concordance of Bipolar I Disorder in a Nationwide Sample of Twins [Electronic version]. The American Journal of Psychiatry, Vol. 161, Iss. 10, 1814-1821.

Vision: Binocular Vision

 

Have you ever thought about the fact that you see out of two different places, but only see one picture? Unless one has vision problems, being able to generate one large image out of two separate eyes is something we humans take for granted. Binocular function is the “ability of the eyes to coordinate their activity so that we can merge the visual fields of both eyes into one distinct image. The most commonly observed aspects of binocular functions include convergence (the ability of the two eyes to team and focus on the same object), and accommodations (the ability of the eyes to shift their focus from near point to far point or vice versa). Each eye can have normal acuity (20/20 vision) but unless the eyes team, visual functions are impaired” (McPeck, n.d.).

The majority of neurons in the striate cortex, “an area of the brain that receives visual impulses, contains a conspicuous band of myelinated fibers, and is located mostly in the walls and along the edges of the calcarine sulcus of the occipital lobe” (Merriam-Webster, 2002), are binocular. These binocular neurons have response patterns that seem to contribute to depth perception. Neurons are able to respond to visual stimulation that occurs in either eye, though the response is stronger when each eye views an image in a separate location. Neurons respond to retinal disparity, which causes images to be produced on different parts of the retina of each eye, so that each eye sees a scene differently and the variation of object distance can be noticed (Carlson, 2004). This “single perception of a slightly different image from each eye, resulting in depth perception” is called stereopsis (Answers, 2006).

In order for an individual to have sharp binocular vision with stereopsis, he or she must have the correct genetics and proper maturity of the binocular system between birth and age four. Though the first few years are critical, most vision aspects are fully developed by six months of age in humans. One study involving a cat’s visual experience illustrates the abovementioned statement. In one part of the experiment, one eye was either patched for several weeks or blurred with a contact lens. The responses of the cells in the visual cortex were then recorded. Before the eye was covered, 80% of the cells were binocular and 20% were monocular. Afterwards, all of the cells became monocular; cells that would once respond to the input from either eye would only respond to input from one eye. This outcome only occurred when the test was done early in life; older cats experienced little change in their binocular vision (Cooper, 2000).

The layout of the face was not just designed with beauty in mind. Our eyes are spaced approximately two inches apart; whereas a horse’s eyes are closer to the side of the head. Horses have a 35 degree wider field of vision than humans. Why would humans be designed to have a smaller field of vision than some animals? The answer is this: it is essential for animals to be able to spot an approaching predator, so they need to see as much area at once as possible. Humans (along with most carnivores and omnivores), on the other hand, need the ability to make accurate judgments about distance and movement. To do this, our field of vision of both eyes must overlap so we can utilize binocular vision (Sight, 2005).

Several visual ailments can arise when damage or improper development of the binocular system occurs. For instance, poor vision in an otherwise healthy eye can be the result of the brain favoring one eye over the other. This normal begins in infancy or childhood and is known as Amblyopia. Wandering eyes or significant differences in refractive error (such as farsightedness or nearsightedness) between the two eyes are major causes of this disorder. Diplopia, commonly known as “double vision”, is a very troubling problem relating to binocular damage. Eye patches were the only cure at one time, but now other methods are in use (pages). Squinting, which may sound like a small annoyance, actually prevents binocular vision because it impairs an individual from using both eyes to look at the same point. Also known as strabismus (or turned eye), squinting can be caused by various things including, but not limited to: cataracts, brain damage, or immobility of a muscle in the eye. Many times, all of these visual disturbances are connected. For instance, when binocular vision is disturbed, Diplopia follows. Infants with Diplopia will squint so they can see one image in one eye (suppressing the vision in the other eye). This is turn causes Amblyopia (Sayer, 2002).

As you can see, binocular functioning plays an essential role in human vision. Without it we would not be able to tell how far away objects were or be able to focus both eyes on one object. Strabismus, Amblyopia, and Diplopia are serious problems that can occur from damage or underdevelopment of the binocular system.
References:

1. Answers Corporation.(2006). Retrieved January 22, 2006, from http://www.answers.com.

2. Carlson, Neil R. (2004). Vision. In Physiology of Behavior, 8, 182-183.

3. Cooper, Jeffrey. (2000). Development of Vision (Critical Periods). Retrieved January 22, 2006, from http://www.strabismus.org/critical_period_Hubel.html.

4. McPeck, Christopher. (n.d.). Retrieved January 22, 2006 from http://pages.prodigy.net/unohu/binocular.htm.

5. Merriam-Webster, Inc. (2003). Retrieved January 22, 2006 from http://www.intelihealth.com/IH/ihtIH/WSIHW000/9276/9276.html.

6. Sayer, Grant. (2002, July 25). Binocular Vision Problems. Retrieved January 22, 2006, from http://www.hon.ch/Library/Theme/VisionFaq/section6.html-.

7. Sight and the Mammal Eye. (2005, Nov 20). Retrieved January 22, 2006 from http://www.earthlife.net/mammals/vision.html.

Non Visual Senses: Vestibular System and Motion Sickness

 

The vestibular system, which consists of the semicircular canals and otolith organs, is located in the inner ear. For the most part, people are unfamiliar with the term “vestibular”, but almost certainly have heard of motion sickness. Have you ever gotten sick from riding in the car or even playing an intense racing game? If you have, then your vestibular system is in operation. The majority of individuals experience some motion sickness in their lifetime, while a small number of persons have either none at all or are highly susceptible (Lacker, 2004.).

When studying biological events, one must reflect on how many different involuntary bodily functions we humans take advantage of every day. The benefits the vestibular system provides are of no exception. Not surprisingly, the vestibular system senses gravity, along with straight and curved movement, which helps to regulate balance. The ears and eyes must work together for us to accomplish simple tasks. For instance, once the vestibular system is damaged, driving or even walking will be difficult or impossible. This condition is called oscillopsia and occurs when your eye muscles do not receive signals to adjust to movement. The vestibulo-oscular reflex, a term for the eye and ear coordination aforementioned, is so responsive that it senses the minute activity made by the head each time we breathe in or out. The brain then sends instructions to our eye muscles to keep focused rather than shifting with motion. Even our heartbeat causes enough movement to impede our vision if the vestibular system is not functioning. Symptoms similar to motion sickness will occur; dizziness and nausea can arise from the simple task of trying to focus one’s eyes (Bauman, 2003). The vestibular system not only works in conjunction with the ocular system, but also alongside the proprioceptive system. This system identifies the activity or location of the body or a limb by reacting to stimuli developing within the individual (Answers, 2006). The vestibular system works with the muscles, thus constant muscle adjustments are possible to help retain balance when shifting positions. (Bauman, 2003).

The vestibular, ocular, and proprioceptive systems are very important for achieving normality in every-day life, but living without one of the three (though challenging) is doable. On the other hand, if only one of the three systems is functioning, maintaining balance is impossible. Once the vestibular system is dead, it no longer transmits signals to the brain; in contrast, if it is merely damaged, it still sends signals- just the wrong ones. Consequently, the side effects of vestibular damage are worse in the initial weeks. Slowly the brain begins to depend on ocular and proprioceptive input more, while vestibular input is almost disregarded. If only one side is injured, nystagmus develops. Nystagmus is an unpleasant condition where frequent eye jerking produces vertigo, nausea, vomiting, and visual problems (Bauman, 2003).

Astonishingly, vestibular damage can also cause memory problems. Though this may sound far-fetched, here is the reason: a once-automatic reflex, balance, now requires great concentration. The area of the brain once reserved for memory and thought processing must now focus on balance control. Fatigue will often emerge in an individual from the constant requirement to concentrate on keeping one’s balance. Imagine what would happen if we had to remember to breathe! Even if it were possible, the exhaustion we would experience would be too much to handle. Muscular aches and pains may also arise. One must constantly stiffen his or her muscles to maintain his or her balance. Trying to keep the head absolutely still can bring about headaches, as well as a sore neck. As it is plain to see, living without a properly functioning vestibular system can be more than worrisome- it can be downright painful (Bauman, 2003).

Now that the basic functioning of the vestibular system is somewhat clearer, the concept of motion sickness will be easier to understand. Motion sickness was originally used to define sickness caused by unusual movement, such as sea, train, or swing sickness. Presently, the term motion sickness is used to describe any movement, or perception of movement, that causes an uneasy feeling. Physical movement is not required for an individual to experience motion sickness. For example, I myself have had a horrible bout of motion sickness brought on by playing a video game that was in first person view. My eyes were sending messages to my brain that I was going down a steep hill, yet my vestibular system did not sense any movement. My stomach had a “lurching” feeling, then nausea and dizziness set in; some people even experience vomiting, headache, and drowsiness. Though damage to the vestibular system can be severe, motion sickness is not one of the symptoms. On the contrary, partial damage will cause an individual to be less likely to experience motion sickness; complete loss of vestibular function eliminates motion sickness. Prescription and over-the-counter drugs are available to combat motion sickness, though little is known about how they work (Bauman, 2003). Dramamine, an over-the-counter drug, is believed to work either by “acting on the balance mechanisms in the ear or on the part of the brain that controls vomiting” (Dramamine, 2001).

While motion sickness may not be pleasant, I personally would much rather feel a little nauseas from time to time then to have a malfunctioning vestibular system. I can not imagine the difficulty of maintaining constant concentration just to walk or keep my head still. In my opinion, vestibular damage would cause life to be much less enjoyable, at the very least. Every time you ride in a vehicle and feel a little queasy, be thankful that your vestibular system is functioning properly and that your uneasiness will soon disappear!

References:

1. Answers Corporation. (2006). Retrieved January 28, 2006 from http://www.answers.com.

2. Bauman, Neil. (2003). Protect Your Balance System—Or Else. Retrieved January 22, 2006 from http://www.hearinglosshelp.com/BalanceSystem.htm.

3. Dramamine-CMI. (2001). Retrieved January 28, 2006 from http://www.appco.com.au/appguide/drug.asp?drug_id=00072429&t=cmi.

4. Lackner, James. (2004). Motion sickness. Retrieved January 22, 2006 from
http://www.graybiel.brandeis.edu/publications/PDF/191_ms_encns.pdf.

Motor Cortex and its 4 primary tracts

 

The motor cortex, located in the cerebral cortex, is the starting point for electrochemical transmissions that travel from the nerve centers to the muscles. The primary motor cortex is positioned on the precentral gyrus. The precentral gyrus is a bulging ridge that is on the back area of the frontal lobe (the biggest part of each cerebral cortex). It is bound by the central sulcus (located between the frontal and parietal lobes) and the precentral sulcus, which is in front of and parallel to the central sulcus. The primary motor cortex is located just in front of the central sulcus (Carlson).

The organization of the primary motor cortex is somatotopic. This means that the layout of the motor cortex corresponds to different body parts. The supplementary motor cortex and the premotor cortex lie adjacent to the primary motor cortex. Both are involved in arranging movements, which they carry out by interacting with the primary motor cortex. Moving, or even envisioning movement, stimulates these areas. The two auxiliary motor cortexes obtain signals from sections of the parietal and temporal cortex, informing them of what is happening and where it is occurring. For example, the cortex involved in vision is separated into two streams, dorsal and visual. The ventral stream helps answer the “what” of vision- perceiving and recognizing objects- and ends in the temporal cortex; while the dorsal steam helps answer the “where” of vision- perception of location- and ends in the parietal cortex. The parietal lobes also help answer the “how” of vision by organizing visually guided movements. This somatotopic arrangement allows different areas of the brain to control different body parts (Carlson, 2004).

The lateral group is principally involved in the management of independent limb movements; its primary job is controlling the action of the hands and fingers. When the right and left hand move in different manners at the same time, or one moves while the other stays motionless, independent limb movement is taking place (Carlson, 2004).

The corticospinal tract, which is part of the lateral group, is one of the four principal motor tracts and has two sections- lateral and ventral. It is composed of axons that come to an end in the gray matter of the spinal cord. Most of the cells that control these axons are in the primary motor cortex, but axons are also sent through the corticospinal pathway by neurons in the parietal and temporal lobes. The majority of axons in the lateral (side) corticospinal tract are formed in the areas of the primary and auxiliary motor cortexes that control the distal sections of body parts; for instance, the fingers, arms, feet, and toes. Once joined with motor neurons in the spinal cord, synapses are formed. Muscles of the distal limbs are controlled by these motor neurons. Alternatively, axons of the ventral (middle) corticospinal tract form in the upper leg areas of the primary motor cortex and descend to the proper area of the spinal cord. They then divide and propel terminal buttons into both sides of the gray matter. As a result, motor neurons are regulated and can move the muscles of the torso and upper legs (Carlson, 2004).

Another member of the lateral group, the rubrospinal tract, is the second principal motor tract. This tract starts in the red nucleus of the midbrain and obtains its key indicators from the motor cortex through the cerebellum and the corticorubral tract (which controls the movement of the face, neck, tongue, and some eye muscles). The rubrospinal tract’s axons end on motor neurons in the spinal tract; these neurons are responsible for controlling the forelimb and hindlimb muscle movement (Carlson, 2004).

The third principal motor tract, the vestibulospinal tract, is part of the ventromedial group. This group gets information from the areas of the primary motor cortex that control movement of the trunk, along with muscles close to the body (Carlson 2004). The vestibulospinal tract plays a vital role in maintaining posture, along with controlling adjustments of the head and muscles involved in balance (n.a., 2002).

Lastly, the reticulospinal tract, also a part of the ventromedial group, has many cell bodies located in nuclei of the brain stem and midbrain. The neurons control essential automatic functions, such as respiration, sneezing, coughing, and muscle tonus (a state of partial muscle contraction). Additionally, they also control voluntary actions controlled by the neocortex; walking is one example (Carlson, 2004).

In conclusion, the motor cortex controls movement in the body through different motor tracts. The four primary tracts include the corticospinal, rubrospinal, vestibulospinal, and reticulospinal tract. The corticospinal and rubrospinal tracts are in the lateral group which controls independent limb movements. The corticospinal tract controls the distal sections of body parts, along with the muscles of the torso and upper legs; while the rubrospinal tract controls the forelimb and hindlimb muscles. The vestibulospinal and reticulospinal tracts are in the ventromedial group which controls movement of the torso and muscles close to the body. The vestibulospinal tract controls posture, head adjustments, and balance; while the reticulospinal tract controls many automatic functions and voluntary neocortex functions.
Reference:

1. Brain Picture. Retrieved January 28, 2006 from http://www.emc.maricopa.edu/faculty/farabee/BIOBK/cerebrum_1.gif.

2. Carlson, Neil R. (2004). Control of Movement. In Physiology of Behavior, 8, 254-259.

3. N.a. (2002). Retrieved January 29, 2006 from http://sprojects.mmi.mcgill.ca/cns/histo/systems/motor/main.htm.

Narcoleptic symptoms in Parkinson’s Patients

 

Narcolepsy is a chronic sleeping disorder that is more than disruptive, it can be deadly. Patients with this disorder experience excessive daytime sleepiness, or EDS, and are prone to fall asleep at inappropriate moments. Most individuals have bouts of daytime sleepiness when their normal sleep routine is interrupted, or they do not put aside the recommended eight-hours a day; but individuals with narcolepsy have these bouts of EDS no matter how much sleep they get. Narcolepsy has been misdiagnosed because it is often mistaken for other disorders, such as depression. Statistics show that this disorder affects at least 200,000 people in the US, and most are not diagnosed until fifteen years after the initial onset of symptoms (Green & Stillman, 1998).

To have a better understanding of sleeping disorders, one must know the mechanism of sleep. When an individual is awake, he or she shows either alpha or beta brain activity. Alpha activity can be characterized as a state in which a person is not excited or avidly thinking, and includes normal, medium- frequency brain waves of 8-12Hz. Beta activity consists of erratic low-amplitude waves of 13-30 Hz, and normally occurs when someone is alert and in an active thinking process. When an individual becomes drowsy, they enter stage one sleep where some theta activity is displayed; this stage lasts for around ten minutes and can be described as a “prerequisite” to sleep. Stage two sleep still consists of theta activity, but also includes sleep spindles and K complexes. Sleep spindles are short busts of waves occurring two to five times a minute during stages one to four; while K complexes only occur during stage two and are sharp waveforms that can be triggered by noises. Fifteen minutes later, stage three sleep begins, along with delta activity. An hour and a half after falling asleep (or forty-five minutes after stage four), REM sleep begins. Stage four sleep is referred to as Rapid Eye Movement sleep because our eyes move back and forth. During stage four, dreams are likely to take place. Though dreams can occur in other stages, narrative dreams normally are distinctive of REM sleep. For the remainder of the night, individuals have twenty to thirty minutes intervals of REM sleep, and then fifty to sixty minute intervals of non-REM sleep (Carlson, 2004, 276-279).

A study was conducted in the Department of Psychiatry and Neurology at the Karl Franzens University Hospital in Graz, Austria to determine the correlation of sleep attacks in patients taking dopamine agonists for Parkinson’s disease. Dopamine agonists are drugs that combine with a receptor or cell to produce a physiologic reaction similar to that of dopamine (Answers, 2005). Rather than conducting a face to face study, researchers reviewed articles published between July 1999 and May 2001 that discussed narcoleptic-like attacks in patients with Parkinson’s disease. Twenty different publications were selected to include a total of 124 patients that had both attended movement disorder clinics and had sleep ailments; this amounted to nearly seven percent of patients taking dopamine agonists. It should be noted that two-thirds of these patients were men, and dosage amounts varied. Patients had diverse durations of treatment and were included whether or not former symptoms of sleepiness had occurred. Two types of sleep events were found: those without warning and those with drowsiness indicators before the attack. Unsurprisingly, researchers concluded that population based studies were needed to formulate a strategy for the avoidance and treatment of sleep disorders in patients taking dopamine agonists for Parkinson’s disease (Homann, et al., 2002).

Though further research is needed about the aforementioned topic, significant findings were produced. Heated debates have arisen, but this study supports the theory that sleep attacks, not just normal drowsiness, are present in Parkinson’s patients who take dopamine agonists. For example, seventeen of these patients fell asleep at the wheel from a sudden sleep attack, which resulted in ten car accidents. Pramipexole and Ropinirole, two dopamine agonists, were initially believed to be the cause; but now all dopamine drugs are possible factors. Additional non-driving attacks were reported, with twenty patients having recurrent sleep events (Homann, et al., 2002).

Because of the controversy involved and the belief that sleep attacks in Parkinson’s patients are too infrequent to be named as a significant problem, no principal treatment has been found. Twenty-five of the included patients either stopped taking dopamine agonists or reduced their dosage; twenty-two of these patients stopped having sleep attacks and three had reduced attacks. Three patients switched dopamine agonists; one patient’s attacks recurred, while the other two went into remission. Other patients had success with changing their medication schedule to correspond with the time they needed to be awake. Also, common narcoleptic treatments were administered. For example, the stimulant modifil worked as a successful treatment in one patient. Another patient found pulling over to take a nap when experiencing sleepiness while driving would keep him from having sleep attacks (Homann, et al., 2002).

Dopamine-like drugs have been known to cause normal drowsiness, but this is the first study that has addressed bouts of overwhelming sleep attacks. Personally, I found this surprising because it is alleged that up to thirty percent of Parkinson’s patients taking dopamine agonists have sleep attacks. Of course, publication bias in this study might have led to an overestimate. It does seem that males and individuals with damage to the autonomic nervous system might be at a higher risk. Also, health authorities of the United States, Canada, and Europe have acknowledged the danger of Pramipexole and Ropinirole and asked the makers to warn users not to drive or participate in similar activities (Homann, et al., 2002).I found this study interesting because in our textbook, Physiology of Behavior, irregularity of the hypocretin system was said to be the cause of narcolepsy. Dopamine is a neurotransmitter, much like hypocretin (Carlson, 2004, 282). The loss of functioning in Parkinson’s patients is due to a decrease in dopamine; therefore, dopamine agonists are given to supplement that lost. I would be inclined to think that the disruption of the dopamine system is what causes the sleep attacks if it were not for the fact that symptoms seem to disappear once the agonist is ceased. In addition, L-DOPA, another agonist that is used to compensate for dopamine loss, often causes involuntary movements and a worsening of symptoms in Parkinson’s disease (265). Schizophrenia is thought to be brought about by too much dopamine, and dopamine agonists can cause an onset of this disorder in some individuals (519). In addition, if one searches on http://www.google.com for “dopamine and sleep”, a plethora of articles will come up. This supports the findings that dopamine agonists are linked to sleep attacks in some fashion. Carlson also mentions the relationship between REM sleep behavior and Parkinson’s disease (283). It is suggested that dopamine agonists are responsible for this correlation (Gagnon, Montplaisir & Bedard, 2002). The theory that dopamine agonists are to blame for sleep attacks in patients with Parkinson’s disease presents a different point of view than the textbook for a possible cause of narcoleptic-like symptoms.

References:

1. Answers Corporation. (2006). Retrieved February 02, 2006, from http://www.answers.com

2. Carlson, Neil R. (2004). Physiology of Behavior, 8.

3. Gagnon J., Montplaisir J., & Bedard M. (2002). Rapid-eye-movement sleep disorders in Parkinson's disease [Electronic version]. Rev Neurol (Paris), 158, 135-152.

4. Green, P. & Stillman, M. (1998). Narcolepsy [Electronic version]. Archives of Family Medicine, 7, 472-478.

5. Homann, C., Wenzel, K., Suppan, K., Ivanic, G., Kriechbaum, N., Crevenna, R., et al. (2002). Sleep attacks in patients taking dopamine agonists: review. BMJ Publishing Group Ltd. Retrieved February 02, 2006, from http://bmj.bmjjournals.com/cgi/content/full/324/7352/1483

Phineas Gage and the Orbitofrontal Cortex

 

The day of September 13, 1848 marked the beginning of research involving the relationship between the prefrontal lobe and human behavior. Phineas Gage, a railroad foreman, was unearthing rock when a thick piece of iron smashed through the left side of his face. It entered below the cheekbone and came out through his skull. People were shocked when the blow did not kill him, and even more amazed that he was able to speak within a few minutes. Dr. John Martin Harlow, the attending physician, observed the changes in Gage’s personality for the next thirteen years until Gage died from a series of epileptic seizures, and also convinced his family to allow his skull to be exhumed five years later. Before the accident, Gage was known as a competent and adept employee; after the accident, he was rude, impulsive, profane, and negligent. His rational thinking and emotional processing was so impaired that he lost his job. Harlow’s reports, though not readily accepted, were confirmed for the most part by an experiment on monkeys in 1878; thus the analysis of the prefrontal lobes began (Larner & Leach, 2002).

The prefrontal lobe is responsible for formulating plans and strategies, along with a person’s “personality” (Carson, 2004, 84). The orbitofrontal cortex (OFC), part of prefrontal lobes, is located at the base of the frontal lobes right about the eyes. This cortex makes up an important part of who we are by regulating our emotions. The OFC receives input from the dorsomedial thalamus and the temporal cortex (both linked to memory); the ventral tegmental area (associated with the reward system); the olfactory system; and the amygdala, which is tied to anger. It then sends signals to the branches of the limbic system (responsible for moods and emotions) including: the cingulate cortex, the hippocampal formation, the temporal cortex, the lateral hypothalamus, and the amygdala; along with other areas of the frontal lobe. The inputs consist of environmental information, and the outputs regulate one’s behavior and physiological responses, essentially emotion. These inputs and outputs help establish the OFC as an interface between brain mechanisms, such as automatic learned and unlearned emotional reactions, along with complex behaviors (351-352).

Studying primates’ brains and behaviors is a good way to learn about the OFC; unfortunately, rodents’ orbitofrontal cortexes are too small to get significant information from. Some researchers consider the OFC the secondary taste cortex because it receives stimuli from the primary taste cortex in primates. Taste can act as a primary reinforcer; therefore, the OFC taste neurons are controlled by hunger. For instance, a monkey will eat until it is full. Once full, the OFC neurons no longer respond; whereas, the neurons of the primary taste cortex are regulated by the identity of taste, not the reward value. Therefore, the reward value of taste is represented in the OFC. One area of the OFC responds to sweet tastes (those with glucose), while another is activated by the taste of salt. This concept goes for pleasant touch, nice smells, and also foul smells; each works in a different area of OFC. Fatty foods give off a pleasant sensation because the brain knows these foods will probably contain high calories and essential fatty acids. There are even OFC neurons that respond to textures and temperature of food (Rolls, 2004).

It has been shown that smells activate neurons in the OFC of monkeys and in the ventral front region of humans. Thirty-five percent of these neurons are influenced by taste association, while the other sixty-five percent are completely dependent on the odor itself. Just as in taste, the OFC neuron activity decreases when monkeys are full, and the value of odor is represented in this cortex. In addition, the inferior temporal cortex sends visual inputs directly to the OFC. Individuals react differently to items or images depending on their reward association. For example, OFC face-responsive neurons convey signals to one by sending different responses for dissimilar faces and expressions. This is also a method of reinforcement; an area of the OFC responds to face expression by signifying behavior should change. Somatosensory inputs (touch, pain, etc.) are sent from the postcentral gyrus; and the amygdala transmits signals to the caudal (“tail end”) of the OFC. The more pleasure and pain there is, the more OFC activity occurs. Patients with damage to the ventral part of the frontal lobe may feel pain, but report that it does not feel very bad (Rolls, 2004).

As it is clear to see, the OFC takes care of many important functions by combining sensory observations and the reward system, among other things. As a result, when this area of the brain is damaged, many behavioral abnormalities will arise. Inappropriate behavior and emotional changes are imminent, as seen in the Phineas Gage case. Patients will become more impulsive, along with performing worse with stimulus-reinforcement associations. They typically show greater unprovoked emotions of anger and less unwarranted happiness. Also, their sense of time is impaired. In my opinion, the impulsive nature they display may partially be attributed to their belief that time is moving faster (Berline, Rolls, & Kischka, 2004). Misinterpretations of others’ moods, lack of initiative, and unconcern or underestimation of the gravity of a situation are all side effects that hinder patients’ relationships and every day lives. Frontal lobe damage can cause patients to be unable to plan or correct certain behaviors, though they can verbally express the right course of action (Rolls, 2004). Individuals that have lesions on their dorsolateral prefrontal cortex display problems with spatial working memory, unlike people with damage to the OFC (Berline, et al., 2004).

The ability to respond to social reinforcers and the reward system are an essential part of any primate’s life. Not knowing how to respond to facial expressions on someone can be hazardous. What an OFC patient might consider to be a joking expression may be anything but that. Some patients also have problems with voice recognition, but both face and voice recognition problems do not always occur together. “Bilateral surgically circumscribed (but not usually unilateral) lesions of the human orbitofrontal cortex produce deficits in a probabilistic version of a visual discrimination reversal task with monetary reward (Rolls, 2004). For instance, when a person is gambling and receives money, the medial OFC is activated; when a person loses money, the lateral OFC is activated. In a person with normal OFC activity, a person will have better control when gambling because his or her OFC alerts the individual to be aware of the dangers of losing. Someone with damage to this cortex may not have any apprehensions when betting and any bad feelings when losing (Rolls, 2004). Believe it or not, even bladder control is related to the OFC. Patients with bladder control problems show little activity in this area when their bladders are full, compared to individuals with normal activity (Swyers, 2006).

Many patients with mental disorders have abnormal activity in their OFC. Unsurprisingly, research has revealed that patients with bipolar disorder, which has characteristics of extreme mood swings, have abnormalities in several brain areas that control emotion. The amygdala and hippocampus are smaller in both children and adults, which suggests that even though symptoms may not progress until a later time, brain changes are an early feature in this disorder. Frontal areas of the brain, such as the OFC and anterior cingulate also show abnormalities. These irregularities may be caused by a gene known as BDNF, which produces a factor involved in the development of brain structures. When bipolar patients were depressed, the activity in the OFC was extremely high; when the patients were manic, the activity was very low. This occurrence makes sense because patients with OFC damage are impulsive and easily agitated, much like manic bipolar patients; whereas, people that had an overly active OFC would most likely be overly emotional (Bipolar 2003). Another great reference site for this phenomenon is located at http://www.neurotransmitter.net/bipolarpfc.html; it reports many studies dealing with the aforementioned topic. In post traumatic stress disorder, the amygdala and associated areas are activated by traumatic stimuli. The OFC is less capable of inhibiting the activation; and the activation of the amygdala, along with neurotransmitter and endocrine activity, produce many of the symptoms in PTSD (Excerpt, 2005). Patients with obsessive compulsive disorder show heightened activity in the OFC and anterior cingulate gyrus. The hyperactivity of these areas cause excessive signals to be sent to the basal ganglia; which in turn, causes patients to report a feeling that something is wrong (Gladding, 1999).

In conclusion, the orbitofrontal cortex and frontal lobes play a vital part in regulating our emotions and behaviors. Though unfortunate, the accident that Phineas Gage was involved in provided an important building block for research of this brain area. Many disorders show abnormal orbitofrontal activity, and further research is sure to explore this fascinating structure.
References:

1. Berlin, H.A., Rolls, E.T., Kischka, U. (2004). Impulsivity, time perception, emotion and reinforcement sensitivity in patients with orbitofrontal cortex lesions [electronic source]. Oxford Journals, 127, 1108-1126.

2. Bipolar Disorder and the Brain. (2003). Society for Neuroscience. Retrieved February 5, 2006, from http://apu.sfn.org/content/Publications/BrainBriefings/bipolar_disorder.htm

3. Excerpt from Posttraumatic Stress Disorder. (2005). Emedicine. Retrieved February 7, 2006, from http://www.emedicine.com/med/byname/posttraumatic-stress-disorder.htm

4. Carlson, Neil R. (2004). Physiology of Behavior, 8.

5. Gladding, Becky. (1999). Neurobiology for Obsessive-Compulsive Disorder (OCD). Westwood Institute for Anxiety Disorders. Retrieved February 7, 2006, from http://www.hope4ocd.com/research/schwartz1299.html

6. Larner, AJ & Leach, JP. (2002). Phineas Gage and the beginnings of neuropsychology [Electronic Source]. History of Neurology & Neuroscience. ACNR, Vol. 2, No. 3, 26.

7. Rolls, Edmund. (2004). Convergence of Sensory Systems in the Orbitofrontal Cortex in Primates and Brain Design for Emotion [Electronic Version]. The Anatomical Record Part A, 281A, 1212-1225.

8. Swyers, Jim. (2006). Overactive Bladder Related To Orbitofrontal Cortex Activity. Retrieved February 7, 2006 from http://www.medicalnewstoday.com/medicalnews.php?newsid=36593

Sexual Intercourse, Emotions, and the Frontal Lobes

 

When initially posed the question of whether or not sexual intercourse in humans could take place without emotional processing, I assumed the answer was yes. How can prostitutes have sexual relationships with many people everyday and have emotional feelings also? What about porn stars or swingers? Before this discussion, I would not have hesitated in saying that these individuals do not have emotional ties while having intercourse (at least not all intercourse), but my view has significantly changed.

Erections and ejaculation are controlled by spinal reflexes. Even men that have spinal damage (where the spine is disconnected from the brain) can reach an erection and become fathers; though they could not have an orgasm, or be conscious of the fact that they were erect without visual or verbal confirmation (Carson, 2004, 331). Extensive research has led me to the conclusion that only in rare cases, such as the example just mentioned above, or in the case of an unconscious rape victim, can an individual be a participant in sexual intercourse without an emotional response. Even holding this opinion, I can not intelligently state that human sexual intercourse could take place without emotional processing. At least one partner would have to exhibit an emotional response to the physical process.

 

A plethora of hormones and brain areas interact to control sexual functions. Testosterone, estradiol, androgen, and progesterone are hormones involved in sexual functioning. One hormone, oxytocin is released in both males and females during orgasm, to facilitate contractions of muscles in the sexual organs. The medial preoptic area, the sexually dimorphic nucleus, the medial amygdala, and areas of the limbic system, along with various other areas of the brain, play a role in sexual functions. Most areas of the brain involved in sexual processing are larger in males than in females. Studies have shown that these areas in male transsexuals are around the same size as females, and that the areas in male homosexuals are significantly smaller as well. Also, in a study with male rats, it was found that maternal stress reduces the size of the sexually dimorphic nucleus, and that these males had more feminine characteristics. Researchers of a twin study reported that if one identical male twin was homosexual, the other twin had a 52% chance of being concordant, while fraternal twins only had a 22% chance; in females the percentages were 48 and 16, respectively. The previous findings support the theory that sexual preference has a genetic basis, rather than sustaining the idea that they “chose to be” that way (Carlson, 2004, 309-340).

When studying the biological areas responsible for sexual functioning, it is almost impossible to miss the fact that most of these areas also control emotional functioning. For example, studies have shown that amydgala activity increased in humans when watching an erotic film, opposed to a normal video (348). In one study, men were asked to respond naturally when watching an erotic film. The men were sexually aroused; and consequently, their amydgala, hypothalamus, and other areas of the limbic system showed increased activity. When asked to detach themselves from the video and not become aroused, the men were able to do so. In this case, rather than having increased activity in the limbic system, the activity occurred in the prefrontal cortex (354). This supports the theory that emotional responses can increase or suppress sexual responses.

Though physical symptoms can cause sexual impotency, a lot of problems are psychological. For example, individuals with schizoid personality disorder are found to be emotionally cold and detached. They have a detachment from social relationships and find difficulty in taking pleasure in few, if any, activities. Thus, they rarely show interest in having sexual intercourse with another individual (Stroup, 2002). The basis for this stems from the fear of having an intimate relationship with someone. Most adults with schizoid fears have an underlying attachment disorder due to an insufficient mother-infant relationship (Alperin, 2001). Generally, sexual dysfunction is caused by a response to something else and does not lie completely in the genitals. Stress, relationships, and learning are all contributing factors. Sexual responses can start in the body, mind, or emotions; but three break points can occur to inhibit the response. First of all, inappropriate stimulation or pain can cause a negative response. Secondly, anxiety, pressure, self-consciousness, or any other negative emotions can reduce sexual stimuli. Lastly, sometimes one’s mind is too busy to become relaxed enough for arousal to take place. All of these situations are common, and will have a diminishing affect on sexual enjoyment. Even premature ejaculation could be called an “emotional disorder,” because it can be treated by helping a man to learn how to control his feelings and response time. Accordingly, compulsive sexual behavior, more often than not, can be controlled by behavior modification therapy (Ramage, 1998).

Multiple Sclerosis is thought to be an autoimmune disease of the central nervous system. The name comes from the effects of the disease- myelin is lost in multiple areas, leaving sclerosis (scar tissue) in its place. In regular human brains, myelin protects nerve fibers and allows them to function correctly. In patients with Multiple Sclerosis, the electrical impulses of the nerves are disrupted, which causes many symptoms. Regular exacerbations occur in 85% of people with this disease, and are essentially “flare-ups”, or severe declines in neurological functions. One study, in the Archives of Neurology, discussed research of the occurrence of acquired sexual paraphilia (extreme abnormal sexual behavior) in patients with M.S. Sexual dysfunction, which includes erectile and ejaculatory dysfunction in men, poor lubrication and the inability to reach orgasm in women, and diminished libido in both sexes, is typical in patients with M.S. Patients in this study showed quite the opposite symptoms, including hypersexual behavior and paraphilias. All were found to have various focal brain lesions. One man in the study displayed inappropriate sexual activity during an exacerbation, consisting of an irresistible desire to touch women’s breasts. Neuroimaging was used to discover lesions in the right sides of the midbrain and hypothalamus, stretching into the right sides of the substantia nigra, the red nucleus, and the internal capsule. Significant evidence was presented that acquired sexual paraphilic behavior in patients with M.S. results from inflammatory demyelination that involves the septal and hypothalamic regions of the basal forebrain (Frohman, Frohman, & Moreault, 2002). This study supports the theory that when areas of the brain responsible for emotional processing are damaged, abnormal sexual responses will occur.

In conclusion, there is a thin line between emotions and sexual stimuli in humans. For most animals, intercourse is a primal instinct used to further their species by reproduction and is impossible outside of the ovulation period. In contrast, human intercourse is not only important to further our species, but also to tie a physical act with the need for emotional intimacy with a partner. Psychological disorders, more often than not, have an effect on sexual enjoyment. Many areas of the brain, chiefly sections of the limbic system, play an important part in the emotional and physical aspects of sexual intimacy. Emotions are a vital part of normal sexual processes, and to separate the two functions is not only rare, it is nearly impossible.

References:

1. Alperin, Richard. (2001). Barriers to Intimacy: An Object Relations Perspective [electronic version]. Psychoanalytic Psychology, Vol. 18, Issue 1.

2. Carlson, Neil R. (2004). Reproductive Behavior & Emotion. Physiology of Behavior, 8, 309-372 .

3. Frohman, E., Frohman, T., & Moreault, A. (2002). Acquired Sexual Paraphilia in Patients With Multiple Sclerosis [electronic version]. Archives of Neurology, Vol. 59, No. 6, 1006-1010.

4. Ramage, Margaret. (1998). Management of sexual problems [electronic version]. ABC of Sexual Health, 317, 1509-1512.

5. Stroup. (2002). Personality Disorders. Neurobiology of Psychiatry: Syllabus & notes. Retrieved February 11, 2006 from www.med.unc.edu.

Memory Structures

 

Memory, an essential part of life and independence, is primarily stored in the cerebral cortex. The inferior temporal cortex stores visual memory; whereas, the frontal cortex stores associations. New declarative memories, involving facts and events, are formed in the hippocampus and related structures in the medial temporal lobe (Myers, 2005). The entorhinal cortex supplies the majority of the information that is sent to the hippocampus (Carson, 2004). Some researchers believe that the hippocampus is similar to a temporary holding cell and memories slowly seep into the permanent storage area of the cerebral cortex. This process could be compared to an inbox; once the inbox is full, items are archived into a different area. On the other hand, the majority of researchers believe that the hippocampus does not store information, but instead is needed to help create new memories (Myers, 2005). Carson agrees with the latter, and that the hippocampus inputs information from the sensory and motor cortex, processes the information, modifies the memories, and links them together in ways that can be more easily remembered (Carson, 2004).

The amygdala plays a vital role in memories of an emotional nature. Someone with amygdala damage may be able to remember details of an event, but will forget emotional information (memory). The right prefrontal and bilateral hippocampal gyrus, which surrounds the hippocampus, is associated with visual (picture) memory; while word associations are connected to the left prefrontal and left hippocampus gyrus. The left hemisphere of our brains is responsible for encoding memories, and the right hemisphere is in charge of retrieving memories. Medial temporal and midline diencephalic processing, composed of the thalamus and hypothalamus, control the consolidation of memories; which, as a result, enables long-term memory processes to occur (Long, n.d.). Bilateral anterior lesions on the thalamus can cause permanent amnesia, while posterior lesions do not normally cause a noteworthy problem. The severity of anterior thalamus damage can affect both hippocamal and perirhinal pathways (because of the location); and in turn, disrupt the “transmittal” of memory from one area to another. For example, one well known case involves a man that has had amnesia since 1960 due to a brain injury. The patient’s verbal memory was destroyed, but he has no problem with other cognitive functions. Even as far back as 1988, researchers were able to produce evidence that lesions in the dorsomedial nuclei and the hippocampal tracts cause a memory disorder. The location and extent of the lesions determined the severity of the memory deficit. Accordingly, left-sided lesions produce verbal memory loss, while right-sided lesions produce memory loss of a visual nature (Ringholz, 2000).

The caudate nucleus, located in the lateral ventricle of the brain, regulates the organization and priority of information sent to the frontal lobes. Individuals with Huntingdon Disease often have many memory difficulties due to damage of the connection between this region and the frontal lobes. Unlike patients with Alzheimer’s disease, patients with HD cannot learn or recall motor memories, so their speech is often slurred; stuttering is common; and body movements are also uncontrollable. They can recall memories, but not find the right words to express them. Also, they can remember experiences when given choices to pick from and benefit from cues- exactly the opposite of patients with Alzheimer’s disease. Without organization, memories only matter so much. Memory problems in HD can be compared to reading a book where the pages or words in a sentence are all out of order. Everything is there, but it still does not make any sense. Even though these individuals can understand what someone is saying, response time is extremely slow due to the brain’s “search mechanism” being damaged. Actions that were almost “unconscious” at one point, such as driving or walking, will now become very difficult because intense concentration will be required (Cognitive, 2004).

Memory, unlike many of the brain’s functions, is something that most people (especially students) think of from time to time. Not being able to recall someone’s name or an important piece of information can be very embarrassing or frustrating, to say the least. Damage to areas such as the hippocampus, amygdala, thalamus, and caudate nucleus can cause memory problems. Memory is so complex that memory loss is actually “specialized”. Some people may have trouble with short-term memory, while other people have trouble with long-term memory. The organization of memories or even creating new memories may be impossible. My memory is not “the best”, but I feel fortunate that I can at least put sentences together, remember what I ate last, and recall vital information. Without these traits, life would be much more difficult and confusing.
References:

Carlson, Neil R. (2004). Learning and Memory: Basic Mechanisms. Physiology of Behavior, 8, 411-450.

Cognitive Symptoms X1. (2004). HOPES. Retrieved February 15, 2006 from http://www.stanford.edu/group/hopes/diagnsis/cognitiv/x1.html

Long, C.J. (n.d.). Memory. Retrieved February 12, 2006 from http://neuro.psyc.memphis.edu/NeuroPsyc/np-ugp-memory.htm

Myers, Catherine. (2005). Memory. Memory Loss and the Brain. Retrieved February 12, 2006 from http://www.memorylossonline.com/glossary/memory.html

Ringholz, George. (2000). Summary and Discussion: Patient #44. Baylor Neurology Case of the Month. Retrieved February 15, 2006 from http://www.bcm.edu/neurology/challeng/pat44/summary.html.

Mind or Memory Transfer: Is it a Possibility?

Mind transfer has been a popular fictional theme of many movies, but the more technology progresses, the closer this theme gets to becoming a reality. Because of the fact that so many natural chemicals already function to enhance, sustain, or transfer memory in the human brain, the concept of actual mind transfer is not new. Scientists have been researching the possibilities for over a century now. In 1908, Charles Guthrie, an American scientist, “made” a two-headed dog by removing the head from another dog’s body and connecting blood vessels. Though the additional head had gone without oxygen for too long to properly function, it did exhibit basic reflexes such as blinking. Forty-three years later, Vladimir Demikhov attempted to duplicate the experiment more rapidly, so that damage would not occur in the additional brain. Believe it or not, it worked; but the additional head was quite aggravated and bit the other head’s ear off. Another problem also existed: the immune system rejected the new tissue, and the dogs would die. By the 1960s, this problem was also solved with immunosuppressant drugs, still currently used in human organ transplants (Weir, 2004). Furthermore, in 1962 Psychologist James McConnell discovered evidence supporting the theory that untrained flatworms could acquire knowledge through the consumption of trained worms. Other experiments have led researchers to believe that memory can be transferred by injecting brain extract from one animal (rats or mice) to another (Chemical, 1968).

The subject of mind (or memory) transfer is very controversial for many reasons. First of all, scientists have had trouble reproducing results from other studies. For example, in 1969 Paul Pietsch and Carl W. Schneider performed a study involving brain transplantation of salamanders in hopes of supporting previous indications that suggest memory transfer is possible. They inserted brains from trained salamanders into the coelomic (body) cavities of untrained larvae. Even though some increased performance was displayed in the transplant animals, no evidence of memory transfer was found. The salamanders had to be trained in order for the enhanced performance to take place. This does not meet the criteria of “true” memory transfer, which would consist of automatic knowledge without training (Pietsch & Schneider, 1969). Even after these disappointing results were publicized, Pietsch and Schneider, along with other scientists, did not discard the idea. By 1970 “head transplants,” or White’s preferred terminology “full body transplants,” had been successfully conducted on primates. Fourteen years later, Dr. Robert White felt the techniques he used in these operations were advanced enough for human subjects (Weir & Human, 2004, 1988).

The second obstacle is trying to transfer someone’s mind without the actual brain. For starters, the brain already moves memories and information on a continual basis. As far as we know, it is not a static set of neurons that can be replaced with an alien set of data. Synaptic connections actually evolve to fit a set of experiences. Even if we were able to transfer someone’s brain into a robot’s body, the limitations of that brain would still be there. The process of transferring memories is even more problematic. Because of the brain’s constant and high-speed activity, building a static model of one’s brain would not be adequate. Also, memories are not as simplistic as a video tape. They are an individual’s personal outlook on past experiences. No matter what the situation, the same question asked by an interviewer almost always results in a plethora of unique answers. Sure, the same concept might be there, but the way a person remembers the situation is different. By applying this way of thinking to the notion of memory transfer, one can see the potential dilemma. Even if a piece of “memory” is transferred into someone’s head, that person’s perception of the recollection might be completely unique. Also, gaining instant knowledge could trigger a type of overload to the brain (prohibiting vital functions), drastically change an individual’s personality, and cause numerous other problems. The question of whether or not an individual will still be the same “person” is debatable; but in my personal opinion, doubtful (Phillips, 2000). Finally, some of the most gifted individuals including, but not limited to: Woolf, Beethoven, Tolstoy, Van Gogh, Newton, Michelangelo, Churchill, and even Abraham Lincoln, suffered from mental illness. Would this instant knowledge also bring about “craziness”?

The only way the aforementioned question could be brought to any kind of supported conclusion is through experimentation; everything else is nothing but speculation and personal opinion. Hence, the third (and most challenging) obstacle arises: ethics. Ethical dilemmas are prevalent in many every-day medical procedures. The more knowledge humans gain, the more open most people are to new ideas. Nevertheless, cloning of any living organism or even using stem cells in the umbilical cord blood later in life are highly-debated topics. Even if we were able to transfer memories from one human to another, experimentation must take place on humans to perfect the technique. This would be dangerous, and have serious moral considerations, even if individuals willingly agreed.

If one discards the moral issues and complications involved in memory (or mind) transfer, there are several techniques that could be utilized. Taking multiple over-lapping holograms of memories and placing them on a single molecule, which is then inserted in the brain, is called hologramic theory. This concept came from evidence that even organisms without brains (such as bacteria, etc.) store memories on molecules (Pietsch & Schneider, 1969). Another idea is to form an MRI image of an “open skull,” while magnetically and electrically recording movement by movement neuron pulses. A program would then be made, “fine-tuned”, and copied to brain tissue. An alternative would be to connect the corpus callosum to computer cables and upload/download information (Phillips, 2000). Serial sectioning, or slicing, freezing, and scanning layers of the brain, is yet another idea. The scans could be combined later on, and uploaded to an artificial brain or a human’s brain by combining other techniques (Burton, 1999). If cell-sized machines could be transplanted in one’s brain, artificial neurons could possibly be formed and inserted into the brain in place, or in addition, of/to the neurons already there (Jacques, 2005). Various alterations on these theories exist, and I am sure as research progresses, knowledge and thoughts will only increase.

As you can see, transferring memory or the “mind” has many complications and moral issues with it. I personally believe that one day it will indeed be possible. The further technology grows the closer we become. Many theories have already been publicized and similar research has been done for over a century. What will this emerging technology do to the human race as we know it, if it is finalized? It is hard to imagine all the positive possibilities, along with all the dreadful outcomes that could occur. Who knows, a future clone of mine could remember writing this discussion…Almost scary, isn’t it?

References:

Burton, Brent. (1999). Automated 3D Reconstruction of Neuronal Structures from Serial Sections. Retrieved February 18, 2006 from http:// research.cs.tamu.edu/bnl/pubs/burton_thesis.pdf

Chemical Transfer of Fear [electronic version]. (1968, April 19). Time Magazine, Vol. 91, No. 16.

Human Head Transplants. (1988, Sept.). New Zealand Anti-Vivisection Society. Mobilise, 22.Retrieved February 18, from http://www.nzavs.org.nz/mobilise/22/print/6.html

Jacques, Robert. (2005). Scientists Fret over nanotech breakthrough. Retrieved February 18, 2006 from http://www.vnunet.com/vnunet/news/2137318/scientists-fret-nanotech-breakthrough

Pietsch, P. & Schneider, C. W. (1969). Brain transplantation in salamanders: an approach to memory transfer [electronic version]. Brain Research, 14, 707-715.

Weir, Kirsten. (2004, Dec. 3). Getting a head: who will volunteer for the first head transplant? Current Science. Retrieved February 18, 2006 from http://www.findarticles.com/p/articles/mi_m0BFU/is_7_90/ai_n8589469

Phillips, Winfred. (2000). Chapter 4: The Mechanism of Mind Transfer. In The Extraordinary Future. Retrieved February 18, from http://www.mind.ilstu.edu/published/Phillips/PhillipsCh4.html

Theoretical Orientation: Carl Roger

 

When doing research on different psychological theorists, some of the ideas (especially older ones) were shocking to me. I have read several books on insane asylums. I do not mean psychiatric hospitals; I mean asylums of decades ago. Scientists once believed that anything from nearly drowning patients to pulling out all of their teeth could cure individuals with psychiatric illnesses. I am sure that to most people these theories probably sound bizarre, but before psychology was an accepted field of medicine, they were every day occurrences.

I find Carl Roger’s theory of personality to have the most relevance in conjunction with my career goals in the field of psychology and helping others in general. Roger’s theory, often called “person-centered”, is a humanistic personality theory that evolved from his work as a clinical psychologist. Rogers believes humans have a tendency to develop attributes that will enhance themselves and move them closer to autonomy, the process of formulating one’s own morals and personal law. He thinks that this tendency can be suppressed, but not destroyed. I agree with this part of his theory to an extent. I do believe that most individuals form their own set of morals. Even many serial killers have their limit. For example, child rapists are normally not welcome in jail. They may be surrounded by criminals, but most people do not take kindly to child abuse. On the other hand, I do believe there are individuals that are so deranged or mentally ill, that they have no morals or guilt what-so-ever (Pescitelli, Analysis 1996).

The second part of Roger’s theory involves something he calls the “phenomenal field”. This field is composed of all the experiences (conscious and subconscious) the individual has undergone and is what we base our “self” picture on, or more simply put, who we are. He believes that along with the self-awareness aspect is the “need for positive regard from others” and “the need for positive self-regard”. “Conditions of worth” are formed when parents base love on a child’s action (conditional love) and can be very damaging (Pescitelli, Analysis 1996)

The reason why I chose the “person-centered” theory is because of Roger’s therapy concept. He believes that a therapist should not disagree or point out contradictions; instead, he or she should free a person by removing obstacles so the person can become independent and self-directed. The therapist has to “have unconditional positive regard for the client as well as show emphatic understanding”. The therapist must be genuine, but he or she is not expected to be perfect. He or she should accept his client’s personal self-worth regardless of his feelings, condition, or situation he or she is in (Pescitelli, Rogerian 1996).

Though I do not agree with everything about Roger’s theory, I think that, for the most part, it is a great guide to structure a psychology career around. Carl Roger was known to be a gifted clinical psychologist. He took a huge step by recording his sessions so others could study and learn from them. I strive to have the emphatic understanding he did and to have genuine respect for my future clients.

1. Pescitelli, Dagmar. (1996). An Analysis of Carl Rogers’ Theory of Personality in Personality & Consciousness. Retrieved January 16, 2006, from http://panda.ca/?cat=carl_rogers&page=rogerian_theory

2. Pescitelli, Dagmar. (1996). Rogerian Therapy. Retrieved January 16, 2006, from http://panda.ca/?cat=carl_rogers&page=rogerian_theory

Applying the Taxonomy in Practical Discussions

 

Using the basic tenets illustrated in Bloom’s Taxonomy is essential for being a productive critical thinker. First, one must have a general knowledge of the information he or she is researching. If one does not know what different terminology means, how will one understand the subject matter? Also, being aware of past theories and studies of the topic is vital when striving to form a valid hypothesis from new information obtained.
Bloom describes knowledge as remembering previously learned information. Recalling statistics, lists, and views are only a few examples of obtaining sufficient knowledge. One must be able to understand the information he or she gathers. What good is memorizing results for past studies if no insight is gained from them? If one can explain past theories or studies in a way that others can understand, then he or she most likely has a proficient comprehension of the subject matter (Bloom, 1956).

Without application of the knowledge learned, obtaining a plethora of information will serve no purpose. One must use the previously learned information to solve new problems, preferably in new situations where results will be easily illustrated. For example, repeating a past study that already has a solid conclusion in the exact manner as before will most likely do little good. Unless some aspect is altered or the first experiment was publicized incorrectly, the results will be the same. Also, using an inanimate object to study human behavior would not provide accurate, if any, results (Bloom, 1956).

After the new study is done, the results must be analyzed in the proper manner. Past generalizations should be compared, along with possible motives and causes. Diagrams, correlations, or illustrations should be utilized in processing the information. As mentioned above, information that is not put to use is futile. Once the researcher comes to an educated conclusion, the experiment results must be put to use in some manner. Why do animal research studies on cancer, only to find a cure and not utilize it in treatment?
Even once this information is applied to practical situations, it should be evaluated. The FDA does not allow a new medication to be placed on the market without thorough testing, application, and follow-up. Most medications undergo years of evaluation before being released (Bloom, 1956).

All of the following steps aforementioned are equally important in the critical thinking process and should be utilized when doing research. The first step I use in writing a paper (or posting) is to relate the discussion question to current knowledge I have. Even if I am not familiar all aspects of the question, I try to link the main topic to something I am familiar with. For example, in one class I was asked to discuss the motor cortex and its 4 tracts. I knew little about the motor cortex, but was aware it was part of the brain in the cerebral cortex; this led me to the conclusion that it most likely controlled movement in the body. Once researching the issue, many terms were difficult to understand. I looked up anything that was confusing in the dictionary or other sources, sometimes looking up words in, not only the first definition, but also subsequent definitions. Looking up definitions helps me to comprehend the information, as well as have proficient knowledge of the terminology. After collecting the information I need, I compared different studies and tried to make an easy to understand explanation. Afterwards, I will use others’ evaluation of my paper to decide whether my conclusion was informative or lacking. If the paper was enlightening, I will use that information in further discussions and experiences.
Reference:

Bloom, Benjamin. (1956). Major Categories in the Taxonomy of Educational Objectives. Retrieved January 30, 2005 from (http://faculty.washington.edu/krumme/guides/bloom.html)

Understanding Attachment Disorders in Children

(Click above to see the story behind the picture) 

An article entitled Understanding Attachment Disorders in Children was published by the Center for Family Development. This article explains the reasons why the attachment system in an infant-mother relationship is as important as feeding and reproduction in human survival. For instance, a baby’s self-worth comes from the attention his mother bestows on him. If the mother does not respond to his or her cries, the child will feel he or she is unworthy of attention. I found this article interesting and of importance because it helps to explain the problems children encounter when not given the proper attention as an infant, as well as ways to counter the problems once they exist (Center, 2005).

First, to understand attachment disorders, one must understand the concept of attachment bonds and affectional bonds. Affectional bonds consist of five basic tenets. Bonds must be persistent and involve a specific person who has no substitute. The relationship must be emotionally significant; and the individual who develops the affectional bond must want to stay in contact with the other person, incurring sadness when unwilling separated. Normally an individual has many affectional bonds. A sixth condition is required for a true attachment bond to be formed; an individual seeks security and comfort in the relationship. Babies usually have more than one attachment bond, but have a single preferred attachment. For example, when a mother responds to her baby’s cries, a strong affectional bond develops between the pair. This is said to be the building block for a child’s relationships later in life. Young babies will cry, reach for, or cling to their mother when hungry, tired, frightened, or lonely. Toddlers normally see their mother as a secure “place”. They tend to wander off to explore, but often look back for eye contact or call out to hear their mother’s voice. By the time a child is four, they are normally alright with separation, as long as it is agreed upon (Center, 2005).

Second, patterns of attachment must be understood. The way a mother responds to a child’s needs for help, attention, or protection determines the quality of the child’s attachment. As mentioned above, a true attachment bond involves security. If safety is acquired, the bond will be secure; otherwise, it is insecure. The most used research method for measuring attachment, a procedure called Strange Situation, was utilized in this study. The child is taken away from the mother, given to a stranger briefly, and then reunited; with the child’s reaction being the deciding factor to classify the attachment as secure, avoidant, resistant, or disorganized/disoriented. Children that have a secure attachment actively seek contact with their mother, along with being distressed on separation or displaying less comfort with a stranger. The reunion of a securely attached child is a happy one and many times the child will not let go of the mother. Children with avoidant attachment will often ignore their mother when reunited and many times find more comfort in a stranger’s arms. Resistant children have mixed reactions. At first they may want contact, but then push their mother away or run away from her. Unlike avoidant children, they do not prefer strangers and stay angry at the stranger, along with the mother. Disorganized or disoriented behavior normally stems from a child finding their attachment frightening. They may try to avoid or resist their mother; or they may be confused or frightened by her. Many times mothers with disorganized or disoriented children fight violently with their partner, mistreat their child, or abuse alcohol (Center, 2005).

Now that an understanding of how attachment works has been created and different patterns have been identified, one should be able to understand attachment disorders. Reactive attachment disorder, as stated in the DSM-IV, is composed of emotional withdrawal, emotional promiscuity, and/or indiscriminate behavior and could be labeled as a “non-attachment disorder”. Most often children with this disorder have not had one main attachment to depend on, so they do not know how to become attached even as adults with children of their own. If they have emotional promiscuity, they try to use their bodies to gain affection; whereas indiscriminate behavior might consist of latching on to a complete stranger as an attachment. Children with disordered attachment have a main attachment figure in their life, but do not have a normal relationship with them. Negative feelings about the relationship are expressed by the child through indirect means. For example, a child may comfort the mother instead of the other way around or do something that is extremely dangerous to his or her own well-being (Center, 2005).

Lastly, once attachment and associative disorders are understood, treatment must be administered. Cradling is one of the principal techniques for babies. This involves physically containing the child while making eye contact to build an emotional bond. If successful, the openness to attachment will transfer from the caregiver to the mother. Some therapists even encourage the older children to wear diapers and use bottles. This technique is based on the theory that attachment is a process that is developed from infancy to adulthood, and in order for a secure attachment to be established, children should regress back to that time. I do not know if I personally agree with this, but I could see some children needing the same comfort an individual should have as an infant. Dyadic Developmental Psychotherapy has been proven to be an affective treatment method for teenagers with trauma-attachment disorders. Infant-parent psychotherapy is another method that focuses on healing a parent’s emotional conflicts in relation to the child’s well-being (Center, 2005).

In conclusion, this article was well-written and helped me to better understanding attachment. By understanding the way attachment is formed, different patterns can be analyzed. Once patterns are analyzed, disorders can be understood. Treatment can then be fashioned through synthesis and should be evaluated for effectiveness. Using this technique to restore attachments in children with both non-attachment disorders and disordered attachments will give them a better chance to form successful relationships later on in life.

References:

Center for Family Development. (2005). Understanding Attachment Disorders in Children. Retrieved January 05, 2006 from http://www.center4familydevelop.com/understandingad.htm

*This can be located at:

Historical Role of Psychologists

<———Click on Me for More Pics of Freud

Defining the role of psychologists in history can be looked at as very simple or very challenging. Psychology in general has played a role in almost every aspect of our lives. From philosophy to geography, from sports to biology, even to the army, the workings of a psychologist are not far behind.

Years ago psychology was not a stand-alone discipline. It played a part in similar studies such as philosophy and even geography. For example, Anaximander, a Greek philosopher, organized a world map in 580 B.C. The world picture of the open universe replaced the closed view of the celestial vault (geocities). Plato stated that the brain is the mechanism of mental processes (387 BC), but was rebutted by Aristotle who stated the heart is the mechanism (335 BC) (allpsych).

It was not until 1821 that Rudolphi Burdach defined physiology as including the study of psychological matter; even so, psychology has played a huge role in the discovery of biology and physical wellness long before it was announced. As early as 1020, Avicenna formed the theory that three ventricles of the brain perform five functions: common sense, imagination, cogitation, estimation, and memory. Vesalius, a Belgian physiologist, started dissecting cadavers in 1543 and by 1616 English physiologist William Harvey was able to explain how the blood circulates. The total separation of body and soul was described in Passions of the Soul by Rene Descartes, the first modern philosopher. In 1774 Luigi Galvani used animal research to test stimulation of a frog’s muscles through electric pulse. An anatomy of the brain was displayed in the book Recherches sur le System Nerveux (1809) by Gall and Spurzheim. By the year 1848, French neurologist Jean-Baptiste Bouillard had come to the conclusion that speech disturbances come from damage to the left frontal lobe and dared to bet 500 francs that he was correct. Thirty-eight years later the British Medical Association listened as Victor Horsley told of a successful surgery for epilepsy. The list goes on, but as one can see, psychologists have played a huge role in the human physiology field (geocities).

In 1883 America began to accept the concept of psychology. John Hopkins University established the first American psychological laboratory. Psychology even intertwined with sports in 1894 when Philippe Tessie published an article about the psychological aspects of bicycle racing. The study of inheritance of human mental characteristics was publicized in 1904 by Karl Pearson. Psychology was even used in the application of legal problems four years later. By 1927 German officer candidates were not even allowed to join the army until a psychology examination had been conducted. Guess who made questionnaires a popular form of acquiring information? You guessed it, a psychologist- Francis Galton, the founder of differential psychology (geocities).

Psychology history can not be mentioned without introducing a few well-known individuals. Sigmund Freud is definitely one of these people. He introduced the concept of psychoanalysis in 1900. In 1913 John B. Watson begins the behaviorism movement (Pereira). Twenty-four years later the book Personality: A Psychological Interpretation by Gordon W. Allport helped to establish personality as a field of academic study. The fight or flight phenomenon was introduced by Walter B. Common in 1932. Finally, Abraham Maslow helped found humanistic psychology and the famous hierarchy of needs (allpsych).

As portrayed above, psychology was, and still is, an important part of our every day life. Human society would not exist without the brain; therefore, the mind will forever be a subject of interest and study.

References:
1. http://www.geocities.com/Athens/Delphi/6061/en_linha.htm
2. Pereira, Marcos. A Timeline of psychological ideas. http://library.thinkquest.org/C005870/history/index.php?id=timeline
3. http://allpsych.com/timeline.html

The”Two-Brain” Theory: Lateralization in the Separate Hemispheres

 

The human brain is asymmetrical in function, but is symmetrical in most structural aspects. Lateralization of the human brain is normally used to describe the asymmetrical functionality of the brain. Though the two sides of the body and brain are virtually mirror images of each other, the functionality of the two sides is partially unique, at the very least. For example, ninety percent of people are “right-handed”. The coordination in their right hand is far superior to the coordination in their left hand. Consequently, one arm or hand is almost always stronger than the other.

As far as the two hemispheres in the brain go, there is little similarity outside of structure; though the mind does strive for symmetry in some aspects. Individuals with obsessive compulsive disorder often have a fixation on things being symmetrical; for example, they will only walk on left-squares of the pavement or must have pictures on the wall perfectly aligned with one another. When this pattern is broken, the patient will experience severe anxiety (Hugdahl, 2005). Because the two hemispheres are functionally lateralized, nerve fibers in the corpus callosum serve as a method of communication between the two sides. Lesions in, or disconnection of, the nerve fibers can cause a person to behave as if he or she has “two separate consciousnesses”. Without this nerve connection, one side of the brain will not know what the other side is doing; hence, the “two-brain” theory was formulated (Cardoso, 1998).

It has been common knowledge for many years that the hemispheres of the brain are responsible for the functionality of the opposite sides of the body. It was not until a later date that scientists had an in-depth knowledge of the specialized functions unique to either the left or the right hemisphere. For instance, the left hemisphere is involved in language and rational tasks, while the right hemisphere is responsible for spatial relations and emotional responses (Cardoso & Hugdahl, 1998, 2005). By 1864, French neurologist Paul Broca discovered that when an individual has a lesion in the middle frontal gyrus of the left hemisphere, he or she will no longer be able to verbally communicate, but can understand when spoken to. This disorder is known as “Broca’s [expressive] aphasia.” Wernicke’s [impressive] aphasia, on the other hand, occurs when a lesion is in the left upper posterior area of the temporal lobe. The patient will have the ability to speak, but can not understand verbal dialogue (Hugdahl, 2005).

The study of epileptics has shed much light on brain lateralization, thanks to the initial research of Robert Sperry (Cardoso, 1998). In 1960-1970, Sperry conducted simple experiments on patients who had undergone surgery for epilepsy. By severing the corpus callosum, seizures can no longer spread from one side of the brain to the other (Hugdahl, 2005). The results of his study were so significant, that he received a noble prize for his efforts (Cardoso, 1998). Sperry placed individuals in front of a screen that had words projected on the left and right sides. He instructed the patients to focus their sight on a central point of the screen, so that any projection on the left would be interrupted by the right hemisphere (due to the ‘x’ shaped crossing of fibers from the eyes to the visual cortex). Amazingly, the patients would report they saw nothing when words were on the left side of the screen; whereas, when words were on the right side of the screen, they not only saw, but could also correctly identify them. Even in the first instance, the patients were able to pick up an item (placed outside their field of view) which corresponded to the words on the screen while using their left hand. How could someone be unable to see a word with their left eye, but be able to pick up the corresponding item with their left hand? The answer stems from the fact that the left hemisphere is responsible for verbal functions. Because the person saw the words with their left eye, the information was sent to be processed in the right hemisphere and then forwarded to the left-hand; since the information did not go through the left hemisphere, the person was not able to verbally express what they saw (Hugdahl, 2005).

Another intriguing finding, which adds to the “two-brain” controversy, is the asymmetry in structure and function of the two sides of the planum temporale. This structure, located in the upper posterior plane of the temporal lobes, is 30-35% larger in the left hemisphere than in the right. The left area of the planum temporale has broader spaced columns and more heavily myelinated axons, which indicate better connectivity per neuron and increased transmission speed, respectively. What makes this structure more intriguing is the fact that it is asymmetric in primates and humans only. Some researchers could hypothesize that humans and primates developed the essential structures for verbal processes, but that something went wrong in the primate’s evolutionary path. On the contrary, individuals opposed to the aforementioned theory could conclude that because chimpanzees do not communicate verbally, but have an asymmetric planum temporale, structure differences do not correlate with language functions (Hugdahl, 2005).

I have trouble making a solid stance on either side of the spectrum; my personal opinion is somewhat in the middle. On one hand, it seems as if the two sides of the brain are just that- two sides in one brain. Many studies have supported the conclusion that both sides are responsible for individual specialized functions. As commonly seen in stroke victims, when one side of the brain is damaged, many crucial human processes are no longer functional, as well as physical operations in an entire side of the body. Alternatively, language studies performed on individuals that had a complete hemispherectomy (or the removal of one hemisphere) differ greatly in children and adults. Even though adults seem to suffer from aphasia after a hemispherectomy, children under five years of age rarely suffer from this disorder. This could imply that language lateralization, though somewhat noticeable in children, does not have a profound effect until after puberty (Krashen, 2002); and that we are born with two separate brains that are capable of functioning independent from one another. Do the two parts of the brain “grow” to become dependent on one another as a person ages? As I stated previously, I am torn between both concepts. If one theory is ever agreed upon universally, I will be very shocked. There are very valid arguments in both cases and even though I might not be in complete agreement with either one, I know without a doubt I want to keep both of my hemispheres in tact!

References:

1. Cardoso, Silvia. (1998). What is Mind? Brain & Mind, No. 4. Retrieved February 20, 2006 from http://www.cerebromente.org.br/n04/editori4_i.htm

2. Hugdahl, Kenneth. (2005). Symmetry and asymmetry in the human brain [Electronic Source]. European Review, Vol. 13, No. 2, 119-133.

3. Krashen, Stephen. (2002). The Neurological Correlates of Language Acquisition: Current Research. In Second Language Acquisition and Second Language Learning, 72-82. Retrieved February 22, 2006 from http://www.sdkrashen.com/SL_Acquisition_and_Learning/076.html

Mental Help Net Website

Mental Help Net is a wonderful source of information for any psychologist or individual interested in psychological disorders. First of all, information about various disorders can be found, including, but not limited to: affective, conversion, childhood, dissociative, eating, impulse, and personality disorders. The news section on this website has well over two hundred different article categories about recent studies, and the majority of these categories have multiple links within them. This adds up to a plethora of information! Psychiatrists and psychologists alike can use this website to find out about break through treatments. Even social workers, school counselors, professors, or individuals in the forensic psychology fields can find important information here pertaining to their career. The large variety of resources provided makes this site even more useful to the common individual as well. One can find book reviews, advice columns, self-help groups, psychological tests, and phone numbers to all the pertinent foundations. In addition, links to different mental health communities are available. A job-seeker can search for positions in the health field, find out about license information, and how to continue their education. Someone wishing to promote their business can advertise on this site. This website has won multiple awards, and it is not hard to realize why. Over 325,000 unique visitors are reported to visit every month. This