We all need ‘Sushi Tuesdays’: Lessons in understanding and finding a way forward after suicide | CNN

Editor’s Note: If you or someone you know is struggling with mental health, help is available. Dial or text 988 or visit 988lifeline.org for free and confidential support.



CNN
— 

When Sam Maya, a beloved husband, father, friend, stockbroker and coach, died by suicide 16 years ago, he left a note. He apologized to his wife, Charlotte, for being a burden and telling her and their two sons, then 6 and 8, that he loved them.

In her recent heartbreaking memoir, “Sushi Tuesdays: A Memoir of Love, Loss and Family Resilience,” Charlotte Maya bears witness to Sam’s life, death and the aftermath with a singular purpose: to humanize the face of suicide and help readers develop a fluency in discussing mental health.

She spent nearly a decade writing “Sushi Tuesdays,” beginning with a blog by the same name, an homage to the weekly ritual she created after her husband’s death.

Every Tuesday while her kids were at school, Maya set aside her overwhelming to-do list as a lawyer and widowed single parent. Tuesdays began with a yoga class, then therapy, followed by whatever she needed most: perhaps going back to bed, going on a hike or heading to a solo sushi lunch.

I met Maya in a memoir workshop last year. I have a family history of mental illness and suicide, so I connected with her work and motivation for sharing her story.

In 2021, suicide was the second leading cause of death for Americans ages 10 to 34, the fifth for ages 35 to 54, and the 11th leading cause of death nationwide, claiming the lives of more than 48,000 people, according to the US Centers for Disease Control and Prevention.

The suicide rate among men in 2021 was nearly four times higher than the rate of women, according to the CDC. Research supports the assumption that men typically choose more effective and lethal means, such as firearms, to complete suicide, according to Dr. Ashwini Nadkarni, a psychiatrist and researcher at Brigham and Women’s Hospital in Boston.

Additionally, men are less likely to seek treatment for depression due to gendered expectations that equate masculinity with emotional stoicism, Nadkarni said.

Suicide is a national health crisis, Maya told me, but when we hear of such a loss, we often attribute each death to the unique problem the deceased faced, such as financial or legal troubles.

These stressors don’t explain suicide, she said. “Lots of people lose money, and they don’t take their own lives. They figure things out.”

When her husband died, Maya knew he had back pain and was stressed about work and money, but she didn’t think these things added up to being suicidal. In retrospect, she can now spot clues, such as his review of his will shortly before he died.

“I wanted to turn back the clock after Sam died,” she said. “I felt so strongly that if I could get back to that morning, I could have changed everything. It’s hard to reckon with what cannot be undone, to face straight into what I did or didn’t do, where I failed, where Sam failed.”

“Whenever I say that Sam made a mistake, the mistake I mean is that he didn’t ask for help,” Maya said. “It’s hard to say you’re suffering when you’re suffering, so let your loved ones know you are available to help.”

Asking people directly about suicidal thoughts may reduce, rather than increase, suicidal ideation, according to a 2014 review of scholarly literature in the journal Psychological Medicine.

That does require that people look for and notice signs that others may be struggling, such as changes in mood, behavior, appetite or sleep habits or that they are giving away cherished possessions.

The writer has since remarried. The combined family includes Gregory Stratz (from left), Tim Stratz, Jason Maya, Parker (the dog), Charlotte Maya, Danny Maya and Daniel Stratz, here in 2011.

Speaking directly about mental health became a trademark of Maya’s single parenting. She aimed for her boys “to live full and fruitful lives, not defined by their father’s suicide, not limited by their father’s suicide, but also not ignoring their father’s suicide.”

Her sons grieved their dad in their own ways, including denial (one pretended his father was on an extended business trip) and rageful episodes that ended with destroyed Lego sets and tears. Maya mourned with them about the “daddy-shaped space in their hearts” but promised that someday they’d be able to say, “I survived my father’s suicide, and I can do anything.”

“It can be awkward to say yes when people ask to help,” Maya said. “Because I was so shocked and overwhelmed, I just said yes. I recommend that course of action to people. Let people show up and help you.”

The support from Maya’s village was so vast that she wrestled with which of her friends would be fully fledged characters in “Sushi Tuesdays” and which would have cameo appearances.

She dealt with this challenge — and the confusion caused by many friends with names starting with the letter J — by cleverly referring to her friends, collectively, as “The Janes.” Given her background as a lawyer, she thought of them as Jane Doe No. 1, Jane Doe No. 2 and so on.

In the book, readers meet District Attorney Jane who helped with the coroner’s office, Engineer Jane who gets the boys to school each day on time and Prayer Warrior Jane who prays for Maya while she’s “not exactly on speaking terms with God.”

One friend, identified not as a “Jane” but as “Bess” in the narrative, is Katherine Tasheff, a college friend from Rice University. When Sam Maya died, Tasheff was a single mother living on a budget in Brooklyn and couldn’t travel to California to visit. So, she did what she could: She wrote her friend an email. And then another. And another. Morning and night for 365 days following Sam’s death.

The emails were always heartfelt and genuine but often mixed with dark humor. In one, Tasheff wrote, “We did an informal poll on whose husband was most likely to take his own life, and I want you to know that Sam came in last place.”

Almost immediately, Charlotte Maya replied, “Dead last?”

This kind of banter fueled Maya, who told her therapist to “call 911” if she ever lost her sense of humor. Finding moments of levity, she said, helped her hold onto her humanity. “Humor doesn’t cancel out what is devastating,” Maya told me. “Just like gratitude cannot cancel out what is horrifying. What’s important is having the capacity to hold both of those things.”

After her husband's death, Charlotte Maya says moments of levity helped her hold on to her humanity.

Seven years after her husband died, in 2014, Maya felt ready to write about surviving his suicide. Tasheff acted with her signature hadn’t-been-asked swiftness, setting up a blog site for sushituesdays.com within an hour.

By then, Maya had met and married the most eligible widower in her town, now nicknamed Mr. Page 179 because that’s where he shows up in the book. They each brought two sons to the marriage. (Coincidentally, each has a child named Daniel, so they now have two Daniels.)

Maya continues to honor her Tuesdays with therapy and yoga, a hike with a friend, and sometimes a sushi lunch.

She urges everyone — especially single parents and anyone managing anxiety or depression — to carve out a similar weekly ritual, even if it’s just an hour to “treat yourself with the same compassion as you treat your dearest friends.”

The coping mechanisms that Maya relied on in her grief may further explain the gender disparity in suicide rates, according to psychologist Lauren Kerwin.

Men may be less likely to have strong support networks or to engage with them when in stress or emotional pain and may be more likely to use maladaptive coping strategies, such as substance abuse or isolation, Kerwin said.

Seeking social connection and professional help is critical to preventing suicide.

“Now, more than ever, we have a better understanding of the neuroinflammatory basis for depression — the medical framework gives us a model in which to consider depression as a medical condition and one which can be treated,” said Nadkarni, the Boston psychiatrist.

If you see warning signs or are worried about someone who may be struggling, the American Foundation for Suicide Prevention recommends you assume you are the only one who will reach out. Find a time to speak privately and listen. Let people know their life matters to you and ask directly if they are thinking about suicide. Then encourage them to use the national suicide hotline by calling or texting the 988 Suicide & Crisis Lifeline, contact their doctor or therapist or seek treatment.

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How psilocybin, the psychedelic in mushrooms, may rewire the brain to ease depression, anxiety and more | CNN



CNN
— 

Shrooms, Alice, tweezes, mushies, hongos, pizza toppings, magic mushrooms — everyday lingo for psychedelic mushrooms seems to grow with each generation. Yet leading mycologist Paul Stamets believes it’s time for fans of psilocybin mushrooms to leave such childish slang behind.

“Let’s be adults about this. These are no longer ‘shrooms.’ These are no longer party drugs for young people,” Stamets told CNN. “Psilocybin mushrooms are nonaddictive, life-changing substances.”

Small clinical trials have shown that one or two doses of psilocybin, given in a therapeutic setting, can make dramatic and long-lasting changes in people suffering from treatment-resistant major depressive disorder, which typically does not respond to traditional antidepressants.

Based on this research, the US Food and Drug Administration has described psilocybin as a breakthrough medicine, “which is phenomenal,” Stamets said.

Psilocybin, which the intestines convert into psilocin, a chemical with psychoactive properties, is also showing promise in combating cluster headaches, anxiety, anorexia, obsessive-compulsive disorder and various forms of substance abuse.

“The data are strong from depression to PTSD to cluster headaches, which is one of the most painful conditions I’m aware of,” said neurologist Richard Isaacson, director of the Alzheimer’s Prevention Clinic in the Center for Brain Health at Florida Atlantic University.

“I’m excited about the future of psychedelics because of the relatively good safety profile and because these agents can now be studied in rigorous double-blinded clinical trials,” Isaacson said. “Then we can move from anecdotal reports of ‘I tripped on this and felt better’ to ‘Try this and you will be statistically, significantly better.’ “

Classic psychedelics such as psilocybin and LSD enter the brain via the same receptors as serotonin, the body’s “feel good” hormone. Serotonin helps control body functions such as sleep, sexual desire and psychological states such as satisfaction, happiness and optimism.

People with depression or anxiety often have low levels of serotonin, as do people with post-traumatic stress disorder, cluster headaches, anorexia, smoking addiction and substance abuse. Treatment typically involves selective serotonin reuptake inhibitors, or SSRIs, which boost levels of serotonin available to brain cells. Yet it can take weeks for improvement to occur, experts say, if the drugs even work at all.

With psychedelics such as psilocybin and LSD, however, scientists can see changes in brain neuron connectivity in the lab “within 30 minutes,” said pharmacologist Brian Roth, a professor of psychiatry and pharmacology at the University of North Carolina at Chapel Hill.

“One of the most interesting things we’ve learned about the classic psychedelics is that they have a dramatic effect on the way brain systems synchronize, or move and groove together,” said Matthew Johnson, a professor in psychedelics and consciousness at Johns Hopkins Medicine.

“When someone’s on psilocybin, we see an overall increase in connectivity between areas of the brain that don’t normally communicate well,” Johnson said. “You also see the opposite of that – local networks in the brain that normally interact with each other quite a bit suddenly communicate less.”

It creates a “very, very disorganized brain,” ultimately breaking down normal boundaries between the auditory, visual, executive and sense-of-self sections of the mind – thus creating a state of “altered consciousness,” said David Nutt, director of the Neuropsychopharmacology Unit in the Division of Brain Sciences at Imperial College London.

And it’s that disorganization that is ultimately therapeutic, according to Nutt: “Depressed people are continually self-critical, and they keep ruminating, going over and over the same negative, anxious or fearful thoughts.

“Psychedelics disrupt that, which is why people can suddenly see a way out of their depression during the trip,” he added. “Critical thoughts are easier to control, and thinking is more flexible. That’s why the drug is an effective treatment for depression.”

There’s more. Researchers say psychedelic drugs help neurons in the brain sprout new dendrites, which look like branches on a tree, to increase communication between cells.

“These drugs can increase neuronal outgrowth, they can increase this branching of neurons, they can increase synapses. That’s called neuroplasticity,” Nutt said.

That’s different from neurogenesis, which is the development of brand-new brain cells, typically from stem cells in the body. The growth of dendrites helps build and then solidify new circuits in the brain, allowing us to, for example, lay down more positive pathways as we practice gratitude.

“Now our current thinking is this neuronal outgrowth probably doesn’t contribute to the increased connectivity in the brain, but it almost certainly helps people who have insights into their depression while on psilocybin maintain those insights,” Nutt said.

“You shake up the brain, you see things in a more positive way, and then you lay down those positive circuits with the neuroplasticity,” he added. “It’s a double whammy.”

Interestingly, SSRIs also increase neuroplasticity, a fact that science has known for some time. But in a 2022 double-blind phase 2 randomized controlled trial comparing psilocybin to escitalopram, a traditional SSRI, Nutt found the latter didn’t spark the same magic.

“The SSRI did not increase brain connectivity, and it actually did not improve well-being as much as psilocybin,” Nutt said. “Now for the first time you’ve got the brain science lining up with what patients say after a trip: ‘I feel more connected. I can think more freely. I can escape from negative thoughts, and I don’t get trapped in them.’ “

Taking a psychedelic doesn’t work for everyone, Johnson stressed, “but when it works really well it’s like, ‘Oh my god, it’s a cure for PTSD or for depression.’ If people really have changed the way their brain is automatically hardwired to respond to triggers for anxiety, depression, smoking — that’s a real thing.”

How long do results last? In studies where patients were given just one dose of a psychedelic “a couple of people were better eight years later, but for the majority of those with chronic depression it creeps back after four or five months,” Nutt said.

“What we do with those people is unknown,” he added. “One possibility is to give another dose of the psychedelic — we don’t know if that would work or not, but it might. Or we could put them on an SSRI as soon as they’ve got their mood improved and see if that can hold the depression at bay.

“There are all sorts of ways we could try to address that question,” Nutt said, “but we just don’t know the answer yet.”

The mycelium, or rootlike structure, of Lion's mane mushroom is part of the

Stamets, who over the last 40 years has discovered four new species of psychedelic mushrooms and written seven books on the topic, said he believes microdosing is a solution. That’s the practice of taking tiny amounts of a psilocybin mushroom several times a week to maintain brain health and a creative perspective on life.

A typical microdose is 0.1 to 0.3 grams of dried psilocybin mushrooms, as compared with the 25-milligram pill of psilocybin that creates the full-blown psychedelic experience.

Stamets practices microdosing and has focused on a process called “stacking” in which a microdose of mushrooms is taken with additional substances believed to boost the fungi’s benefits. His famous “Stamets Stack” includes niacin, or vitamin B3, and the mycelium, or rootlike structure, of an unusual mushroom called Lion’s mane.

Surveys of microdosers obtained on his website have shown significantly positive benefits from the practice of taking small doses.

“These are self-reported citizen scientists’ projects, and we have now around 14,000 people in our app where you register yourself and report your microdose,” Stamets told an audience at the 2022 Life Itself conference, a health and wellness event presented in partnership with CNN.

“I’m going to say something provocative, but I believe it to my core: Psilocybin makes nicer people,” Stamets told the audience. “Psilocybin will make us more intelligent and better citizens.”

Scientific studies so far have failed to find any benefits from microdosing, leaving many researchers skeptical. “People like being on it, but that doesn’t validate the claims of microdosing,” Johnson said. “People like being on a little bit of cocaine, too.”

Experimental psychologist Harriet de Wit, a professor of psychiatry and behavioral science at the University of Chicago, was excited to study microdosing because it solves a key problem of scientific research in the field – it’s hard to blind people to what they are taking if they begin to trip. Microdosing solves that problem because people don’t feel an effect from the tiny dose.

De Wit specializes in determining whether a drug’s impact is due to the drug or what scientists call the “placebo effect,” a positive expectation that can cause improvement without the drug.

She published a study in 2022 that mimicked real-world microdosing of LSD, except neither the participants nor researchers knew what was in the pills the subjects took.

“We measured all kinds of different behavioral and psychological responses, and the only thing we saw is that LSD at very low doses produced some stimulant-like effects at first, which then faded,” de Wit said.

The placebo effect is powerful, she added, which might explain why the few additional studies done on it have also failed to find any positive results.

“I suspect microdosing may have an effect on mood, and over time it might build up resilience or improve well-being,” Nutt said. “But I don’t think it will rapidly fragment depression like macrodosing and going on a trip.”

Obviously, not all hallucinogenic experiences are positive, so nearly every study on psychedelic drugs has included therapists trained to intercede if a trip turns bad and to maximize the outcome if the trip is good.

“This is about allowing someone access into deeper access into their own mental processes, with hopefully greater insight,” Johnson said. “While others might disagree, it does seem very clear that you need therapy to maximize the benefits.”

There are also side effects from psychedelics that go beyond a bad trip. LSD, mescaline and DMT, which is the active ingredient in ayahuasca tea, can increase blood pressure, heart rate, and body temperature, according to the National Institute on Drug Abuse. Ayahuasca tea can also induce vomiting. LSD can cause tremors, numbness and weakness, while the use of mescaline can lead to uncoordinated movements. People hunting for psychedelic mushrooms can easily mistake a toxic species for one with psilocybin, “leading to unintentional, fatal poisoning.”

Another issue: Not everyone is a candidate for psychedelic treatment. It won’t work on people currently on SSRIs — the receptors in their brains are already flooded with serotonin. People diagnosed with bipolar disorder or schizophrenia, or who have a family history of psychosis are always screened out of clinical trials, said Frederick Barrett, associate director of the Center for Psychedelic and Consciousness Research at Johns Hopkins.

“If you have a vulnerability to psychosis, it could be that exposing you to a psychedelic could unmask that psychosis or could lead to a psychotic event,” Barnes said.

Then there are the thousands of people with mental health concerns who will never agree to undergo a psychedelic trip. For those people, scientists such as Roth are attempting to find an alternative approach. He and his team recently identified the mechanisms by which psychedelics bond to the brain’s serotonin receptors and are using the knowledge to identify new compounds.

“Our hope is that we can use this information to ultimately make drugs that mimic the benefits of psychedelic drugs without the psychedelic experience,” Roth said.

“What if we could give people who are depressed or suffer from PTSD or anxiety or obsessive-compulsive disorder a medication, and they could wake up the next day and be fine without any side effects? That would be transformative.”

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Kids need to gain weight during adolescence. Here’s why | CNN

Editor’s Note: Michelle Icard is the author of several books on raising adolescents, including “Fourteen Talks by Age Fourteen.”



CNN
— 

I’ve worked with middle schoolers, their parents and their schools for 20 years to help kids navigate the always awkward, often painful, sometimes hilarious in hindsight, years of early adolescence.

Most of the social and development stretch marks we gain during adolescence fade to invisibility over time. We stop holding a grudge against the kid who teased us in class for tripping, or we forgive ourselves our bad haircuts, botched friendships and cringy attempts at popularity.

But one growing pain can be dangerously hard to recover from, and ironically, it’s the one that has most to do with our physical growth.

Children are supposed to keep growing in adolescence, and so a child’s changing body during that time should not be cause for concern. Yet it sends adults into a tailspin of fear around weight, health and self-esteem.

Kids have always worried about their changing bodies. With so many changes in such a short period of early puberty, they constantly evaluate themselves against each other to figure out if their body development is normal. “All these guys grew over the summer, but I’m still shorter than all the girls. Is something wrong with me?” “No one else needs a bra, but I do. Why am I so weird?”

But the worry has gotten worse over the past two decades. I’ve seen parents becoming increasingly worried about how their children’s bodies change during early puberty. When I give talks about parenting, I often hear adults express concern and fear about their children starting to gain “too much” weight during early adolescence.

Parents I work with worry that even kids who are physically active, engaged with others, bright and happy might need to lose weight because they are heavier than most of their peers.

Why are parents so focused on weight? In part, I think it’s because our national conversations about body image and disordered eating have reached a frenzy on the topic. Over the past year, two new angles have further complicated this matter for children.

Remember Jimmy Kimmel’s opening monologue at the Oscars making Ozempic and its weight-loss properties a household name? Whether it’s social media or the mainstream press, small bodies and weight loss are valued. It’s clear to young teens I know that celebrities have embraced a new way to shrink their bodies.

Constant messages about being thin and fit are in danger of overexposing kids to health and wellness ideals that are difficult to extract from actual health and wellness.

Compound this with the American Academy of Pediatrics recently changing its guidelines on treating overweight children, and many parents worry even more that saying or doing nothing about their child’s weight is harmful.

The opposite is true. Parents keep their children healthiest when they say nothing about their changing shape. Here’s why.

Other than the first year of life, we experience the most growth during adolescence. Between the ages of 13 and 18, most adolescents double their weight. Yet weight gain remains a sensitive, sometimes scary subject for parents who fear too much weight gain, too quickly.

It helps to understand what’s normal. On average, boys do most of their growing between 12 and 16. During those four years, they might grow an entire foot and gain as much as 50 to 60 pounds. Girls have their biggest growth spurt between 10 and 14. On average, they can gain 10 inches in height and 40 to 50 pounds during that time, according to growth charts from the US Centers for Disease Control and Prevention.

Boys do most of their growing between ages 12 and 16 on average. They may even grow an entire foot.

“It’s totally normal for kids to gain weight during puberty,” said Dr. Trish Hutchison, a board-certified pediatrician with 30 years of clinical experience and a spokesperson for the American Academy of Pediatrics, via email. “About 25 percent of growth in height occurs during this time so as youth grow taller, they’re also going to gain weight. Since the age of two or three, children grow an average of about two inches and gain about five pounds a year. But when puberty hits, that usually doubles.”

The American Academy of Pediatrics released a revised set of guidelines for pediatricians in January, which included recommendations of medications and surgery for some children who measure in the obese range.

In contrast, its 2016 guidelines talked about eating disorder prevention and “encouraged pediatricians and parents not to focus on dieting, not to focus on weight, but to focus on health-promoting behaviors,” said Elizabeth Davenport, a registered dietitian in Washington, DC.

“The new guidelines are making weight the focus of health,” she said. “And as we know there are many other measures of health.”

Davenport said she worries that kids could misunderstand their pediatricians’ discussions about weight, internalize incorrect information and turn to disordered eating.

“A kid could certainly interpret that message as not needing to eat as much or there’s something wrong with my body and that leads down a very dangerous path,” she said. “What someone could take away is ‘I need to be on a diet’ and what we know is that dieting increases the risk of developing an eating disorder.”

Many tweens have tried dieting, and many parents have put their kids on diets.

“Some current statistics show that 51% of 10-year-old girls have tried a diet and 37% of parents admit to having placed their child on a diet,” Hutchison said in an email, adding that dieting could be a concern with the new American Academy of Pediatrics guidelines.

“There is evidence that having conversations about obesity can facilitate effective treatment, but the family’s wishes should strongly direct when these conversations should occur,” Hutchison said. “The psychological impact may be more damaging than the physical health risks.”

It’s not that weight isn’t important. “For kids and teens, we need to know what their weight is,” Davenport said. “We are not, as dietitians, against kids being weighed because it is a measure to see how they’re growing. If there’s anything outstanding on an adolescent’s growth curve, that means we want to take a look at what’s going on. But we don’t need to discuss weight in front of them.”

In other words, weight is data. It may or may not indicate something needs addressing. The biggest concern, according to Davenport, is when a child isn’t gaining weight. That’s a red flag something unhealthy is going on.

“Obesity is no longer a disease caused by energy in/energy out,” Hutchison said. “It is much more complex and other factors like genetics, physiological, socioeconomic, and environmental contributors play a role.”

It’s important for parents and caregivers to know that “the presence of obesity or overweight is NOT an indication of poor parenting,” she said. “And it’s not the child or adolescent’s fault.”

It’s also key to note, Hutchison said, that the new American Academy of Pediatrics guidelines, which are only recommendations, are not for parents. They are part of a 100-page document that provides information to health care providers with clinical practice guidelines for the evaluation and treatment of children and adolescents who are overweight or obese. Medications and surgery are discussed in only four pages of the document.

Parents need to work on their own weight bias, but they also need to protect their children from providers who don’t know how to communicate with their patients about weight.

“Working in the field of eating disorder treatment for over 20 years, I sadly can’t tell you the number of clients who’ve come in and part of the trigger for their eating disorder was hearing from a medical provider that there was an issue or a concern of some sort with their weight,” Davenport said.

Hutchison said doctors and other health providers need to do better.

“We all have a lot of work to do when it comes to conversations about weight,” Hutchison said. “We need to approach each child with respect and without (judgment) because we don’t want kids to ever think there is something wrong with their body.”

The right approach, according to American Academy of Pediatrics training, is to ask parents questions that don’t use the word “weight.” One example Hutchison offered: “What concerns, if any, do you have about your child’s growth and health?”

Working sensitively, Hutchison said she feels doctors can have a positive impact on kids who need or want guidance toward health-promoting behaviors.

Kids can misunderstand doctors' discussions about their weight and internalize incorrect information.

Davenport and her business partner in Sunny Side Up Nutrition, with input from the Carolina Resource Center for Eating Disorders, have gotten more specific. They have created a resource called Navigating Pediatric Care to give parents steps they can take to ask health care providers to discuss weight only with them — not with children.

“Pediatricians are supposed to ask permission to be able to discuss weight in front of children,” Davenport said. “It’s a parent’s right to ask this and advocate for their child.”

Davenport advises parents to call ahead and schedule an appointment to discuss weight before bringing in a child for a visit. She also suggests calling or emailing ahead with your wishes, though she admits it may be less effective in a busy setting. She said to print out a small card to hand to the nurse and physician at the appointment. You can also say in front of the child, “We prefer not to discuss weight in front of my child.”

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Ana Navarro reminds us that being nonwhite doesn’t make you immune from being a white supremacist

Without a manifesto, we still don’t have even the faintest hint of an idea as to what motivated the Covenant shooter all these weeks later, but it took the media next to no time to deduce that the man who murdered eight people at an outdoor mall in Allen, Texas, over the weekend was motivated by white supremacist beliefs.

(Note: CNN has added a photo of another victim, Aishwarya Thatikonda, who is not white.)

Is it possible that the Allen shooter, Mauricio Garcia, had white supremacist beliefs? Sure, it’s technically possible. Occasionally you’ll run across a neo-Nazi type who doesn’t fit the usual mold. White supremacist Holocaust-denier Nick Fuentes reportedly claims to have Mexican heritage.

That being said, it’s pretty disturbing to watch the media fall all over themselves to assign a motive to the shooting without having all the information. It’s an unfortunate pattern that has emerged following mass shootings and more often than not, their narrative turns out to be, if not outright false, at least riddled with holes. Why can’t the media wait for the facts instead of rushing to judgment? Why do they prioritize narratives over facts?

It should come as absolutely no surprise to anyone that the shooting came up on “The View” today, where it became part of a larger discussion among the ladies about mass shootings in America:

So we shouldn’t be taking a closer look at mental health issues and treatments and should instead just keep blaming inanimate objects for violence?

Perhaps the women of “The View” could benefit from some mental health services …

And speaking of race, let’s go back to Ana Navarro for her take on the shooter’s alleged white supremacist ideology:

Thank you, Ana, for that reminder. We were starting to forget what a shameless partisan you truly are (OK, we hadn’t really forgotten, but it never hurts to be reminded).

Honestly, more than anything else, this is annoying. Why is Ana Navarro qualified to decide what does or doesn’t make someone else a white supremacist, but if we, say, point out that Dylan Mulvaney is a biological male who makes a living mocking women, we’re speaking out of turn and disrespecting Dylan’s truth?

Intellectual consistency is not their strong suit. Let’s just put it that way.

However they need to twist it and bend it and deform it. Meanwhile, we don’t recall Ana Navarro and “The View” getting upset about this:

Maybe because to them, racism isn’t an insidious societal disease so much as it is a convenient weapon to deploy against conservatives when the political opportunity presents itself.

Anyway, Ana’s dumb remarks aren’t completely without merit … they actually come in handy if we want to back her into a tight intellectual corner:

By Ana’s criteria, can’t she be a white supremacist, too?

Uh-oh, Ana! We’ve always gotten major white-supremacist vibes from her, you know.

Who’s not a white supremacist?

Our heads hurt thinking about it, so we can’t even begin to imagine how much pain Ana is in right now.

Maybe Mauricio Garcia was a white supremacist. Maybe he wasn’t. Unlike Ana Navarro et al., we’re willing to wait until we know more before making a pronouncement either way. And if it turns out that he was a far-Right neo-Nazi nutball on a homicidal mission, we sure as hell won’t turn him into a martyr like the Left and media have done with Audrey Hale. We’ll tell you that much right now.

***

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‘You’re not alone’: CNN Heroes share advice for Mental Health Awareness Month | CNN

Editor’s Note: If you or someone you know is struggling with suicidal thoughts or mental health matters, please call or text the 988 Suicide & Crisis Lifeline to connect with a trained counselor or visit the Lifeline site.



CNN
— 

May is Mental Health Awareness Month, and this year it seems to coincide with a flurry of violent headlines. For many, this constant bad news adds to the stress of everyday life, which may already feel overwhelming.

According to the National Alliance on Mental Illness, each year in the US, one in five adults experience mental illness and one in six children aged 6 to 17 experience a mental health disorder. That’s millions of people. In 2021, less than half of adults received treatment.

America’s mental health crisis is having a widespread impact that touches everyone.

“One of the things that we underestimate as a society is how our global mental health impacts us as individuals. And we have seen it over and over again as we experience gun violence,” said Michele Neff Hernandez, a 2021 CNN Hero who has helped millions navigate grief and loss through her nonprofit Soaring Spirits. “We can see what happens when people don’t get the help they need; there can be tragic consequences.”

Neff Hernandez is one of many CNN Heroes who have found unique ways to help people with their mental health. Some of them marked Mental Health Awareness Month by sharing advice and insight with CNN’s Elizabeth Belanger about what is working for their communities. Below are edited versions of their conversations.

For Neff Hernandez, whose organization helps widowed people connect with each other in a community of support, it’s important for everyone to know they aren’t alone in their struggle. Mental illness is common, yet the stigma surrounding it is often a hurdle for people seeking the treatment they need.

Michele Neff Hernandez: When our body isn’t working well, going to a doctor to seek the cause or to help alleviate symptoms is considered normal and even responsible. Yet, when we are struggling with our mental health for any reason – including grieving a death, experiencing a traumatic event, even coping with the global and national crises that are a part of our daily narrative – we so often hesitate to seek mental health support. The pervasive stigmatizing narrative that implies that seeking mental health support shows weakness or that a mental illness or the breakdown of our mental health for any reason is something to be ashamed of has a significantly negative impact on our society, especially our young people.

We have to model good mental health care by learning about mental health with the same vigor we use to learn about physical health. Imagine if meditation were as popular as weight loss. Or if picking up your mood stabilizing medication was viewed in the same way as picking up your blood pressure medication. Normalizing caring for and seeking help with mental health is a gift we can give ourselves and the next generation. We all need mental health support at many times in our lives; what a gift it would be if accessing that help were viewed as just part of normal life.

We see this in grief all the time: No one wants to allow people to be sad. We seek to fix instead of listen. We pressure grieving people to “get over it” to make others more comfortable. We set the definition of success after a traumatic event as “returning to normal,” even when returning to a past normal is impossible. The truth is we are always changed by the challenges we overcome, and integrating what we’ve learned about ourselves in the aftermath is one of the key elements of building resilience. When we stigmatize mental health care, we create an environment that ensures that the people who most need help will suffer alone.

Annette March-Grier is a 2014 CNN Hero and the founder of Roberta’s House, a bereavement center in Baltimore, Maryland. Their programs reach more than 4,000 people of all ages each year. In 2021, the organization moved into a new state-of-the-art center where it hosts in-person support groups and serves people who are suffering all types of loss.

March-Grier stresses the importance of putting yourself first to enhance mental well-being.

CNN Hero Annette March-Grier

Annette March-Grier: Everyone is looking for some kind of balance, yet few are finding it. Your state of mind is where it all begins. Make self-care a priority for your mental wellness. “Self-care is not selfish.” It is a truth that if you don’t take care of yourself, you will have nothing to give others. This includes healthy relationships that can be jeopardized because of stress, burnout, and lack of self-care. Your physical health is also connected to your mental health. Negative thoughts and suppression of these can cause dis-ease, and over time this leads to disease.

Self-care means taking time out for self, creating a gratitude list, journaling, dancing, laughing, breathing fully, smelling the fresh air, being aware of surroundings, being in the moment, enjoying the stillness when you can, taking time out for self, playing with your pet, exercising, reflecting on the past, dreaming about the future, eating healthy, helping someone in need. All of these self-care activities increase the body’s endorphins and bring on relaxation and balance.

Sports helped 2012 CNN Hero Scott Strode overcome his addiction to drugs and alcohol. He founded The Phoenix in 2007 to provide free athletic activities and a sober support community to others battling addiction. Today, the organization is in more than 200 communities nationwide with nearly 200,000 members.

Strode’s work focuses on the intersection of exercise and personal connection to benefit mental health.

CNN Hero Scott Strode

Scott Strode: Social connection is a powerful tool for creating positive mental health. At The Phoenix, every day we see the profound impact that belonging and social connection has on our members’ confidence and overall well-being. Just spending a few minutes daily in the presence of others can be inherently powerful, and thankfully it is now easier than ever to make these vital connections.

Whether it’s getting together for an activity or just talking about challenges being faced, social connectivity can help us all overcome mental health challenges.

Exercise can also be a powerful tool to improve mental health. We encourage you to get out for a 15- to 30-minute walk or run and consider inviting a friend to join you. Sharing these physical activities with supportive peers can create the vulnerability to begin to share about what else you might be experiencing.

CNN Hero Mary Cortani

Service dogs are often a helpful tool for members of the military returning from deployment and afflicted by conditions like PTSD, depression, and anxiety. 2012 CNN Hero Mary Cortani’s nonprofit, Operation Freedom Paws, has helped nearly 600 veterans, first responders, and others train their own service dogs.

Cortani emphasizes that not all wounds are visible, and silence is not a treatment for mental illness.

Mary Cortani: If the world has taught me anything, it has taught me to remember to be kind, do not judge what you cannot see. Pain is invisible. With all the craziness going on every day, breathe. It is okay to feel down, to feel overloaded, overwhelmed, sad, frustrated. Try not to hold onto it. Seek help, talk to your family, friends, pastor, priest – talk to someone. And for those listening, really hear, pay attention, because sometimes the silence says more than the words. There is no shame to ask for help. It takes courage, and we all have it within us.

It takes all of us to realize mental health needs to be talked about, not buried under the rug. We need open, honest conversations; we have a mental health crisis in this country that is only getting worse as we become more divided. Fear only adds to it. Mental health doesn’t just affect veterans and first responders; it can affect everyone. Trauma is trauma, and enough repeated exposure changes the brain. There is hope, and there can be healing, but we all need to work together to help those who need our help.

We need to stop the silence surrounding mental health and model healthy behaviors so that we can assist with support and help guide towards resources. We are not in this alone, nor are those suffering from mental health issues.

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Suicides and suicide attempts by poisoning rose sharply among children and teens during the pandemic | CNN



CNN
— 

The rate of suspected suicides and suicide attempts by poisoning among young people rose sharply during the Covid-19 pandemic, a new study says. Among children 10 to 12 years old, the rate increased more than 70% from 2019 to 2021.

The analysis, published Thursday in the US Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, looked at what the National Poison Data System categorized as “suspected suicides” by self-poisoning for 2021 among people ages 10 to 19; the records included both suicide attempts and deaths by suicide.

The data showed that attempted suicides and suicides by poisoning increased 30% in 2021 compared with 2019, before the pandemic began.

Younger children, ages 10 to 12, had the biggest increase at 73%. For 13- to 15-year-olds, there was a 48.8% increase in suspected suicides and attempts by poisoning from 2019 to 2021. Girls seemed to be the most affected, with a 36.8% increase in suspected suicides and attempts by poisoning.

“I think the group that really surprised us was the 10- to 12-year-old age group, where we saw a 73% increase, and I can tell you that from my clinical practice, this is what we’re seeing also,” said study co-author Dr. Chris Holstege, professor of emergency medicine and pediatrics chief at the University of Virginia School of Medicine. “We’re seeing very young ages ages that I didn’t used to see attempting suicide by poisoning.

“It was pretty stunning from our perspective,” he said.

Twenty or so years ago, when he started working at the University of Virginia, he said, they rarely treated anyone ages 9 to 12 for suicide by poisoning. Now, it’s every week.

“This is an aberration that’s fairly new in our practice,” Holstege said.

The records showed that many of the children used medicines that would be commonly found around the house, including acetaminophen, ibuprofen and diphenhydramine, which is sold under brand names including Benadryl.

There was a 71% jump from 2019 to 2021 in attempts at suicide using acetaminophen alone, Holstege said.

The choice of over-the-counter medications is concerning because children typically have easy access to these products, and they often come in large quantities.

Holstege encourages caregivers to keep all medications in lock boxes, even the seemingly innocuous over-the-counter ones.

If a child overdoses on something like acetaminophen or diphenhydramine, Holstege encourages parents to bring their children into the hospital without delay, because the toxicity of the drug worsens over time. It’s also a good idea to call a poison center, a confidential resource that is available around the clock.

“We want to make sure that the children are taken care of in regards to their mental health but also in regards to the poisoning if there’s suspicion that they took an overdose,” he said.

There were limitations to the data used in the new study. It captured only the number of families or institutions that reached out to the poison control line; it cannot account for those who attempted suicide by means other than poison. It also can’t capture exactly how many children or families sought help from somewhere other than poison control, so the increase in suspected suicides could be higher.

The American Academy of Pediatrics has noted that the Covid-19 pandemic exacerbated existing mental health struggles that existed even. In 2021, the group called child and adolescent mental health a “national emergency.” Emergency room clinicians across the country have also said they’ve seen record numbers of children with mental health crises, including attempts at suicide.

In 2020, suicide was the second leading cause of death among children ages 10 to 14 and the third leading cause among those 15 to 24, according to the CDC.

Although the height of the pandemic is over, kids are still emotionally vulnerable, experts warn. Previous attempts at suicide have been found to be the “strongest predictor of subsequent death by suicide,” the study said.

“An urgent need exists to strengthen programs focused on identifying and supporting persons at risk for suicide, especially young persons,” the study said.

Research has shown that there is a significant shortage of trained professionals and treatment facilities that can address the number of children who need better mental health care. In August, the Biden administration announced a plan to make it easier for millions of kids to get access to mental and physical health services at school.

At home, experts said, families should constantly check in with children to see how they are doing emotionally. Caregivers also need to make sure they restrict access to “lethal means,” like keeping medicines – even over-the-counter items – away from children and keeping guns locked up.

Dr. Aron Janssen, vice chair of clinical affairs at the Pritzker Department of Psychiatry and Behavioral Health at Lurie Children’s in Chicago, said he is not surprised to see the increase in suspected suicides, “but it doesn’t make it any less sad.”

Janssen, who did not work on the new report, called the increase “alarming.”

The rates of suicide attempts among kids had been increasing even prior to the pandemic, he said, “but this shows Covid really supercharged this as a phenomenon.

“We see a lot of kids who lost access to social supports increasingly isolated and really struggling to manage through day to day.”

Janssen said that he and his colleagues believe these suspected suicides coincide with increased rates of depression and anxiety and a sense of real dread about the future.

One of the biggest concerns is that “previous suicide attempts is the biggest predictor of later suicide completion,” he said. “We really want to follow these kids over time to better understand how to support them, to make sure that we’re doing everything within our power to help steer them away from future attempts.”

Janssen said it’s important to keep in mind that the vast majority of children survived even the worst of the pandemic and did quite well. There are treatments that work, and kids who can get connected to the appropriate care – including talk therapy and, in some cases, medication – can and do get better.

“We do see that. We do see improvement. We do see efficacy of our care,” Janssen said. “We just have to figure out how we can connect kids to care.”

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Why we have nightmares and how to stop them | CNN

Sign up for CNN’s Sleep, But Better newsletter series. Our seven-part guide has helpful hints to achieve better sleep.



CNN
— 

We leave behind our fears of monsters under the bed as we say goodbye to our childhoods, but one can follow us into adulthood and loom over our heads.

Nightmares are more common in childhood, but anywhere from 50% to 85% of adults report having occasional nightmares.

Almost everyone can experience nightmares.

Dreams do usually incorporate things that happened during the day, leading some researchers to hypothesize that dreams and rapid eye movement sleep is essential for memory consolidation and cognitive rejuvenation,” said Joshua Tal, a sleep and health psychologist based in Manhattan.

“Nightmares are the mind’s attempts at making sense of these events, by replaying them in images during sleep.”

Nightmares are what the American Academy of Sleep Medicine call “vivid, realistic and disturbing dreams typically involving threats to survival or security, which often evoke emotions of anxiety, fear or terror.”

If someone has frequent nightmares — more than once or twice weekly — that cause distress or impairment at work or among people, he or she might have nightmare disorder. Treatments include medications and behavioral therapies.

Addressing frequent nightmares is important since they have also been linked to insomnia, depression and suicidal behavior. Since nightmares can also cause sleep deprivation, they are linked to heart disease and obesity as well.

Trying out these 10 steps could help you ease your nightmares and improve your sleep and quality of life.

Nightmares occur during rapid eye movement sleep, the phase during which our muscles relax and we dream. Waking up during REM sleep enables recollection of the dream and resulting distress, said Jennifer Martin, a professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles, and member of the American Academy of Sleep Medicine’s board of directors.

“One of the most effective ways to treat nightmare problems in adults is actually to get them sleeping more soundly (so) they wake up less often,” Martin said.

A healthy sleep routine begets sound sleep. Develop one by exercising, setting regular sleep and waking times, ensuring your room is dark and cool, avoiding stimulating beverages after midafternoon and engaging in relaxing activities.

Alcoholic beverages can induce restlessness and awakenings throughout the night — potentially helping you remember nightmares, Martin said.

“A lot of people use alcohol as a way to wind down and feel sleepy at the end of the day, but it’s really not the right solution,” she added. Instead, try herbal teas and other beverages conducive to sleep. If drinking was the only part of your relaxation routine, chat with your partner or read instead.

One drink more than three hours before bedtime is OK, Martin said. Just pay attention to whether it causes a post-dinner nap and alertness at bedtime, and eliminate that drink if it does.

Avoid snacking before bed to prevent spiking your metabolism and activating your brain.

Snacking can boost metabolism, which causes your brain to be more active and could lead to nightmares, according to the National Sleep Foundation.

While some people sleep better after eating a light snack, you should stop eating two to three hours before bedtime. If you notice that you have nightmares afterward, try avoiding nighttime snacking or heavier meals before bed.

Some medications can prompt nightmares by interrupting REM sleep.

“If people can identify that their nightmares either started or increased when they had a change in their medication, that’s definitely a reason to talk to their doctor” about their medication schedule or alternatives, Martin said.

Melatonin, while a popular sleep aid, influences our circadian rhythm that regulates REM sleep, and can lead to more or fewer nightmares. If you want to take melatonin for better sleep, work with a sleep specialist to ensure you’re taking it at the right time and not compounding the problem, Martin said.

Calming activities can deactivate your fight-or-flight response and trigger your relaxation system.

Progressive muscle relaxation — tensing muscle groups as you inhale and relaxing them as you exhale — has been effective for reducing nightmares.

“Nightmares activate the sympathetic nervous system, the ‘fight or flight system,’ the body’s natural response to imminent danger,” said Tal via email.

“The body also has an innate relaxation system: the parasympathetic nervous system, aka the ‘rest and digest’ system.” Progressive muscle relaxation and other relaxation activities can help activate that system.

Journaling can help you release your anxieties.

Write down your worries to get them all out ahead of time, lest they rear their disquieting heads at night. Journaling can be helpful for alleviating nightmares and stress in general, Tal said.

Images from any exciting or disturbing content you watched before bed can appear in your dreams.

Since our nighttime observations can appear during sleep, “spend some energy engaging with things that are more emotionally neutral or even positive” before bedtime, Martin suggested.

During the pandemic, our everyday lives are looking pretty scary, too. “Reading the news media and then hopping into bed is more likely to trigger disturbing and upsetting dreams than looking through pictures from your last vacation with your family,” she added.

Imagery rehearsal therapy is effective “when the chronic nightmares are showing similar themes and patterns,” Tal said.

Since nightmares can be learned behavior for the brain, this practice involves writing down in detail the narrative elements of the dream. Then rewrite the dream so that it ends positively. Just before falling asleep, set the intention to re-dream by saying aloud, “If or when I have the beginnings of the same bad dream, I will be able to instead have this much better dream with a positive outcome.”

“By practicing a rewrite during the daytime, you increase your chances of having them at night while you’re sleeping instead of your nightmare,” Tal said.

Silence is key in a sleep routine, but “for people who either don’t like it to be completely quiet or who are awakened by noises they can’t control during the night,” background noise “is a good strategy,” Martin said.

Try a fan or a white noise machine or app for several consecutive nights to help your brain adapt, she added.

If nothing works and you’re still having nightmares, talk with a therapist or sleep specialist.

“Nightmares might be a sign of a larger issue, such as PTSD or a mood disorder,” Tal said. “It is possible to treat the nightmares without treating the underlying disorder, but it may also be helpful to treat both the symptom and the disorder.

“There has been great progress on psychological treatments for nightmares, insomnia, anxiety and mood disorders,” Tal added. “Do not be afraid to ask for help; psychotherapy works and it is often short term and accessible.”

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Working in neuroscience taught me that music is key to our well-being

For many of us, the understanding that music can calm our nerves, improve our mood, and make us feel connected to one another, is largely intuitive.

Parents sing to their babies to facilitate sleep, modulate mood, and scaffold communication. Likewise, adults turn to uplifting music for energy and motivation and soothing music for relaxation and calm.

While such effects can feel mysterious, the truth is that they arise mechanistically from the interaction between musical tones and rhythms with our brains.

Although I had been a musician since I was a child, and had studied the biological foundations of music for more than a decade, the relevance of music’s effects on the brain for mental health was not initially obvious to me.

Intellectually, I understood that music is an important part of human nature, with deep roots in the biology of social communication, which goes a long way towards explaining its emotional power.

Practically, I knew that I looked to music every day as a source of joy, motivation, and connection.

But, perhaps like many basic scientists, I was naïve about how closely such effects align with critical dimensions of mental health (like mood, anxiety, focus, and sociality).

I didn’t understand how overlap in underlying neurophysiology could provide a scientific basis for music as therapy.

Leaving my comfort zone helped me as a scientist

This began to change when, after nearly 10 years abroad completing my studies, I returned to the US for a job in the Department of Psychiatry and Behavioral Sciences at Stanford School of Medicine.

There, I quickly learned about the magnitude of our society’s growing problems with mental health (especially for young people) and the tremendous need for better services.

I also felt the collective frustration with our current best practices (i.e., our best behavioural and pharmacological therapies), which unfortunately have so little to offer so many in need, and which often carry significant burdens through side effects.

In what felt like a cliché at the time, I was also contacted by a start-up, Spiritune, about consulting work within several weeks of my arrival in Silicon Valley.

Despite my initial scepticism, I’ve learned some important things that have changed how I think about the value of music.

In taking a closer look at musical applications in health, I’ve come face-to-face with the mountain of evidence showing that music-based therapies and interventions are broadly effective, e.g., at reducing core symptoms and/or quality of life across many of our most common ailments, including disorders of anxiety, mood, social function, psychosis, and dementia.

Together, these and other insights have made me wonder how much more music could do for us.

What if we stopped thinking about music primarily as a source of entertainment and profit and more as an essential form of social communication with real neurobiological benefits?

This is how we came up with a lulaby for Syrian children

One of the more satisfying applications of my research so far has been in working with Spiritune on the Frequencies of Peace campaign, which seeks to bring a bit of peace to Syrian children in a world plagued by war and natural disasters.

As part of a larger effort to supply toys, blankets, and other sleep aids to these kids, Babyshop, a Middle-Eastern retailer of products for children, came up with the goal of composing a special Arabic lullaby to be played over the radio at bedtime in homes, camps, orphanages, and hospitals all over the region.

The small editorial role played by us in this process was in iterating back and forth with a local composer to help ensure that the final lullaby was acoustically aligned with parameters that communicate peace and calm and that is suitable for use in a context of helping children for whom unpredictability has engendered a fundamental state of hyper-vigilance and anxiety.

While the magnitude of the problems faced by these children, now and in the future, far outweighs what we can hope to have achieved with a single lullaby, the effort remains important in a number of ways.

Can a song really help?

First and foremost, we hope that it will provide some immediate comfort and predictability in the lives of these children while also serving as a window into the tenderness and kindness that exists in the world.

Second, we hope that it will draw attention to the emotional plight of these children and stimulate other local and international partnerships aimed at helping them.

And third, we want this campaign to highlight the tangible value of music for mental health, not only for the most vulnerable but for us all.

The capacity of music to soothe, lull, and generally calm our nerves applies broadly, as does its capacity to stimulate positive emotions, motivate and reward, and bring people together.

These effects have a biological reality that we are increasingly coming to understand, and the effects are just as real as those of other interventions that have become staples of modern mental health care.

Music does more for our mental health than you think

As problems with mental health continue to rise and the world faces new challenges, music will continue to help people, as it always has.

If we continue to overlook this reality, we will miss an important opportunity in a time of need. We need to double down on understanding music’s effects on the brain, promote them, and perhaps most importantly, teach our children how to leverage them.

The onus is thus on scientists, clinicians, educators, musicians, public funders, and private companies to push forward with work that advances the integration of music into our healthcare systems and wellness practices.

This project will not be without its challenges, but the collective knowledge of musicians, music therapists, and biological music researchers can already provide considerable insight into the way forward.

We are also starting to learn how to target musical treatments to individuals with greater precision, which, combined with new technologies, will allow us to develop better ways of getting the right music to the right people at the right time.

All of this is to say that a world in which music does more for our mental health is eminently achievable, and I would encourage anyone who has ever felt moved by music to take it seriously and actively seek out ways in which music can improve their condition.

Daniel Bowling, PhD, is a neuroscientist working at Stanford School of Medicine’s Parker Lab, focusing on auditory-vocal function in human social communication.

At Euronews, we believe all views matter. Contact us at [email protected] to send pitches or submissions and be part of the conversation.

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How to tell when stress is a problem | CNN

It’s National Stress Awareness Month, which means it’s a good time to sign up for CNN’s Stress, But Less newsletter. Our six-part mindfulness guide will inspire you to reduce stress while learning how to harness it.



CNN
— 

As we mark Stress Awareness Month in April, I know there’s so much to be stressed out—mass shootings, wars around the world, the pandemic’s long-term effects and the daily stresses of living and working in the 21st century. I’m sure you’ve got your list.

Everyone experiences stress at different points in their life. But when is stress a problem that requires our attention? What symptoms should people be on the lookout for? What are the health impacts of long-term stress? What are healthy and unhealthy coping mechanisms? And what techniques can help in addressing—and preventing—stress?

Fresh from dropping off my kid at school late (sorry, kid, my fault), I was looking forward to this advice from CNN Medical Analyst Dr. Leana Wen. Wen is an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She previously served as Baltimore’s Health Commissioner and as Chair of Behavioral Health Systems Baltimore.

CNN: Let’s start with the basics. What exactly is stress?

Dr. Leana Wen: There is no single definition of stress. The World Health Organization’s definition refers to a state of worry or tension caused by a difficult situation. Many people experience stress as mental or emotional strain. Others also have physical manifestations of stress.

Stress is a natural reaction. It’s a human response that prompts us to respond to challenges and perceived threats. Some stress can be healthy and can prompt us to fulfill obligations. Perceived stress can spur us to study for a test or complete a project by a certain deadline. Virtually everyone experiences that kind of stress to some extent.

CNN: Why can stress be a problem?

Wen: The same human response that motivates us to work hard and finish a project can also lead to other emotions, like not being able to relax and becoming irritable and anxious. Some people develop physical reactions, like headaches, upset stomach and trouble sleeping. Longer-term stress can lead to anxiety and depression, and it can worsen symptoms for people with pre-existing behavioral health conditions, including substance use.

CNN: What are symptoms of stress that people should be on the lookout for?

Wen: In addition to feeling irritable and anxious, people experiencing stress can also feel nervous, uncertain and angry. They often express other symptoms, including feeling a lack of motivation; having trouble concentrating; and being tired, overwhelmed and burnt out. Many times, people in stressful situations will report being sad or depressed.

It’s important to note that depression and anxiety are separate medical diagnoses. Someone with depression and/or anxiety could have their symptoms exacerbated when they are undergoing times in their life with added stress. Long-term stress can also lead to depression and anxiety.

One way to think about the difference between stress versus anxiety and depression is that stress is generally a response to an external issue. The external cause could be good and motivating, like the need to finish a project. It could also be a negative emotional stress, like an argument with a romantic partner, concerns about financial stability or a challenging situation at work. Stress should go away when the situation is resolved.

Anxiety and depression, on the other hand, are generally persistent. Even after a stressful external event has passed, these internal feelings of apprehension, unworthiness and sadness are still there and interfere with your ability to live and enjoy your life.

CNN: What are the health impacts of long-term stress?

Wen: Chronic stress can have long-term consequences. Studies have shown that it can raise the risk of heart disease and stroke. It’s associated with worse immune response and decreased cognitive function.

Individuals experiencing stress are also more likely to endorse unhealthy behaviors, like smoking, excessive drinking, substance use, lack of sleep and physical inactivity. These lifestyle factors in turn can lead to worse health outcomes.

CNN: What techniques can help in addressing stress?

Wen: First, awareness is important. Know your own body and your reaction to stress. Sometimes, anticipating that a situation may be stressful and being prepared to deal with it can reduce stress and anxiety.

Second, identifying symptoms can help. For example, if you know that your stress reaction includes feeling your heart rate increase and getting agitated, then you can detect the symptoms as they occur and become aware of the stressful situation as it’s occurring.

Third, know what stress relief techniques work for you. Some people are big fans of mindfulness meditation. Those, and deep breathing exercises, are good for everyone to try.

For me, nothing beats stress relief like exercise. For me, what helps is exercising, in particular swimming. Aerobic exercise is associated with stress relief, and mixing it up with high-intensity regimens can help, too.

A lot of people have other specific techniques that help them. Some people clean their house, organize their closets or work in their gardens. Others spend time walking in nature, writing in a journal, knitting, playing with their pets or cycling.

I’d advise that you experiment with what works, take stock of existing techniques that help you and incorporate some of those practices into your regular routine. Then, in times of stress, they are good tools to turn to that you know will help you.

CNN: What unhealthy copings strategies should people avoid?

Wen: Definitely. There are things people turn to in an effort to make themselves feel better in the short-term that can actually make things worse. Excessive alcohol intake, using drugs and smoking aren’t healthy coping strategies. It’s the same with staying up all night, binge-eating and taking out your frustration on loved ones. These have wide-ranging consequences, and you should reconsider them if they have been your go-to coping mechanisms in the past.

CNN: When is it time to seek help?

Wen: If the stress you are feeling is consistently interfering with your work, social or personal life or if you are experiencing signs and symptoms of depression, anxiety and other mental health disorders, it’s time to seek help.

Consider speaking with your primary care physician to get a referral to a therapist. Your workplace may have an Employee Assistance Program that you can turn to, too. And the federal mental health crisis hotline number, 988, is another resource.

This April, for Stress Awareness Month, I hope we can all assess our own stress levels as well as our reaction to stress. We should recognize what helps us to reduce and alleviate stress as we aim to improve our physical and emotional well-being.

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Fatigue Is Common Among Older Adults, and It Has Many Possible Causes

By Judith Graham

Tuesday, April 04, 2023 (Kaiser News) — Nothing prepared Linda C. Johnson of Indianapolis for the fatigue that descended on her after a diagnosis of stage 4 lung cancer in early 2020.

Initially, Johnson, now 77, thought she was depressed. She could barely summon the energy to get dressed in the morning. Some days, she couldn’t get out of bed.

But as she began to get her affairs in order, Johnson realized something else was going on. However long she slept the night before, she woke up exhausted. She felt depleted, even if she didn’t do much during the day.

“People would tell me, ‘You know, you’re getting old.’ And that wasn’t helpful at all. Because then you feel there’s nothing you can do mentally or physically to deal with this,” she told me.

Fatigue is a common companion of many illnesses that beset older adults: heart disease, cancer, rheumatoid arthritis, lung disease, kidney disease, and neurological conditions like multiple sclerosis, among others. It’s one of the most common symptoms associated with chronic illness, affecting 40% to 74% of older people living with these conditions, according to a 2021 review by researchers at the University of Massachusetts.

This is more than exhaustion after an extremely busy day or a night of poor sleep. It’s a persistent whole-body feeling of having no energy, even with minimal or no exertion. “I feel like I have a drained battery pretty much all of the time,” wrote a user named Renee in a Facebook group for people with polycythemia vera, a rare blood cancer. “It’s sort of like being a wrung-out dish rag.”

Fatigue doesn’t represent “a day when you’re tired; it’s a couple of weeks or a couple of months when you’re tired,” said Dr. Kurt Kroenke, a research scientist at the Regenstrief Institute in Indianapolis, which specializes in medical research, and a professor at Indiana University’s School of Medicine.

When he and colleagues queried nearly 3,500 older patients at a large primary care clinic in Indianapolis about bothersome symptoms, 55% listed fatigue — second only to musculoskeletal pain (65%) and more than back pain (45%) and shortness of breath (41%).

Separately, a 2010 study in the Journal of the American Geriatrics Society estimated that 31% of people 51 and older reported being fatigued in the past week.

The impact can be profound. Fatigue is the leading reason for restricted activity in people 70 and older, according to a 2001 study by researchers at Yale. Other studies have linked fatigue with impaired mobility, limitations in people’s abilities to perform daily activities, the onset or worsening of disability, and earlier death.

What often happens is older adults with fatigue stop being active and become deconditioned, which leads to muscle loss and weakness, which heightens fatigue. “It becomes a vicious cycle that contributes to things like depression, which can make you more fatigued,” said Dr. Jean Kutner, a professor of medicine and chief medical officer at the University of Colorado Hospital.

To stop that from happening, Johnson came up with a plan after learning her lung cancer had returned. Every morning, she set small goals for herself. One day, she’d get up and wash her face. The next, she’d take a shower. Another day, she’d go to the grocery store. After each activity, she’d rest.

In the three years since her cancer came back, Johnson’s fatigue has been constant. But “I’m functioning better,” she told me, because she’s learned how to pace herself and find things that motivate her, like teaching a virtual class to students training to be teachers and getting exercise under the supervision of a personal trainer.

When should older adults be concerned about fatigue? “If someone has been doing OK but is now feeling fatigued all the time, it’s important to get an evaluation,” said Dr. Holly Yang, a physician at Scripps Mercy Hospital in San Diego and incoming board president of the American Academy of Hospice and Palliative Medicine.

“Fatigue is an alarm signal that something is wrong with the body but it’s rarely one thing. Usually, several things need to be addressed,” said Dr. Ardeshir Hashmi, section chief of the Center for Geriatric Medicine at the Cleveland Clinic.

Among the items physicians should check: Are your thyroid levels normal? Are you having trouble with sleep? If you have underlying medical conditions, are they well controlled? Do you have an underlying infection? Are you chronically dehydrated? Do you have anemia (a deficiency of red blood cells or hemoglobin), an electrolyte imbalance, or low levels of testosterone? Are you eating enough protein? Have you been feeling more anxious or depressed recently? And might medications you’re taking be contributing to fatigue?

“The medications and doses may be the same, but your body’s ability to metabolize those medications and clear them from your system may have changed,” Hashmi said, noting that such changes in the body’s metabolic activity are common as people become older.

Many potential contributors to fatigue can be addressed. But much of the time, reasons for fatigue can’t be explained by an underlying medical condition.

That happened to Teresa Goodell, 64, a retired nurse who lives just outside Portland, Oregon. During a December visit to Arizona, she suddenly found herself exhausted and short of breath while on a hike, even though she was in good physical condition. At an urgent care facility, she was diagnosed with an asthma exacerbation and given steroids, but they didn’t help.

Soon, Goodell was spending hours each day in bed, overcome by profound tiredness and weakness. Even small activities wore her out. But none of the medical tests she received in Arizona and subsequently in Portland — a chest X-ray and CT scan, blood work, a cardiac stress test — showed abnormalities.

“There was no objective evidence of illness, and that makes it hard for anybody to believe you’re sick,” she told me.

Goodell started visiting long covid web sites and chat rooms for people with chronic fatigue syndrome. Today, she’s convinced she has post-viral syndrome from an infection. One of the most common symptoms of long covid is fatigue that interferes with daily life, according to the Centers for Disease Control and Prevention.

There are several strategies for dealing with persistent fatigue. In cancer patients, “the best evidence favors physical activity such as tai chi, yoga, walking, or low-impact exercises,” said Dr. Christian Sinclair, an associate professor of palliative medicine at the University of Kansas Health System. The goal is to “gradually stretch patients’ stamina,” he said.

With long covid, however, doing too much too soon can backfire by causing “post-exertional malaise.” Pacing one’s activities is often recommended: doing only what’s most important, when one’s energy level is highest, and resting afterward. “You learn how to set realistic goals,” said Dr. Andrew Esch, senior education advisor at the Center to Advance Palliative Care.

Cognitive behavioral therapy can help older adults with fatigue learn how to adjust expectations and address intrusive thoughts such as, “I should be able to do more.” At the University of Texas MD Anderson Cancer Center, management plans for older patients with fatigue typically include strategies to address physical activity, sleep health, nutrition, emotional health, and support from family and friends.

“So much of fatigue management is about forming new habits,” said Dr. Ishwaria Subbiah, a palliative care and integrative medicine physician at MD Anderson. “It’s important to recognize that this doesn’t happen right away: It takes time.”

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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