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Book Review: On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss by Dr. Elisabeth Kübler-Ross and David Kessler

March 2, 2016 9 comments

Book Review: On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss by Dr. Elisabeth Kübler-Ross and David KesslerSummary:
This book presents the science of grief and grieving, based largely upon the lifetime work of renowned psychologist Dr. Kübler-Ross.

Review:
How to review the first book you picked up after losing your 58-year-old father suddenly and unexpectedly to a heart attack? Normally I take a very academic approach to my book reviews (or at least I try to). I can’t review this one that way. I certainly wasn’t in an academic frame of mind when I was reading it. I wasn’t anywhere near my normal frame of mind. So instead, I’ll tell you about my experience reading it.

I found out my father was dead at 7am on a Thursday. I knew my father had been taken to the hospital the night before. My brother, who lives near where my father did, called me to let me know. But he also called me with an update that my father was stabilized. Neither of us was very worried, because my dad suffered from heart disease for eleven years and had been hospitalized periodically. He had a pacemaker. He was on medication. He had a specialist who did his long-term care. The ER was confident in his stability. They sent my brother home. My brother called me and told me to go to sleep. I did. He called me again about an hour later and left a voicemail telling me to call him back. I knew from the voicemail what he was going to tell me. I just knew it. I think I knew it the night before when I went to bed too. Because in spite of being told repeatedly that my dad was going to be fine, I cried myself to sleep that night. My brother, when I called him back, told me that my father had gone into cardiac arrest when they were moving him from the ER to a more specialized heart hospital. In spite of being in an ambulance surrounded by health care workers, the heart attack won.

In any case, the instant I heard the voicemail, I went numb. I woke my husband and told him. I called my workplace. I sent off certain work emails to pass off tasks to others to cover. I texted my friends. Then I sat on our bed and I felt….nothing. I was in a complete and total state of shock, I know now. Largely thanks to this book.

Late that night, when I found it was utterly impossible for me to sleep and was certain I would never sleep again, I reached out to the same thing I’ve always reached out to my entire life: books. I opened my laptop and logged in to the Boston Public Library’s ebooks search. I did not have the ability to go off looking for a print book at a branch. I needed help now. In the middle of the night.

I searched the catalog for “grief,” and got a list of…I dunno, a few books. This one was the most scientific. The rest were quite religious, and while that’s fine for other people, that’s not what comforts me. So I downloaded this, and I started to read it. And I instantly started to feel less like there was something wrong with me.

I learned that it’s entirely normal to go into shock at first. To not feel much of anything. It’s your body protecting you, letting the emotions in a little at a time, as you can handle them, so you will stay safe. And indeed, that night, after the first 12 hours of knowing, I sobbed in my husband’s arms. Thanks to this book, I knew that the numbness could come and go. In fact, the most helpful thing I learned in this book was that the 5 stages of grief (denial, anger, bargaining, depression, acceptance) don’t come in order necessarily, and they’re not neat. You don’t move through them in an orderly fashion. You may be angry one day, depressed the next, in denial another, and feel ok and accepting for a bit, then right back to depression. And that’s normal and ok.

I also learned, which was really important for me to know, that the stage of anger can sometimes express itself as guilt, which is just anger turned inward. Some people are more likely to turn their anger inward, and I am definitely one of them. Knowing this was where my (irrational) guilt was coming from (god knows I couldn’t possibly have saved my father from a heart attack from hundreds of miles away) made it much easier for me to cope with the feelings when they did come up.

There were other particular things that the book predicted might happen that kept me from getting freaked out when they did. For instance, I periodically was certain my phone had buzzed with a text message from my father. So certain, in fact, that I picked it up to check. Twice I thought I saw my dad on the street. Both of these I may have been concerned were abnormal, but the book reassured me these “ghost sightings” are totally normal. It’s your body and brain readjusting to your new reality.

The book also gave me warnings about things to come. Things like how the first holidays without the person or the person’s birthday would be difficult. So I knew to expect that and prepared myself for it. It also talked about being patient with yourself in things like dealing with the loved one’s possessions. Not to rush yourself, that it’s ok to take a little bit of time. There were also warnings about how quickly the person’s scent will fade that meant I took the time to really smell a couple of my dad’s tshirts, because I knew the scent would be one of the first things to go.

There is a “specific circumstances” section that talks about things like multiple losses simultaneously or suicide. I wish this section had a bit more on various other special circumstances. For instance, I had just gotten married 7 weeks before, and then my father died. I would have loved a section talking about the juxtaposition of such happiness with such sadness, and how to handle the emotions of things like your first married Thanksgiving (so happy!) also being your first Thanksgiving without your father.

Overall, this book gave me guidance of what to expect from my grief in the immediate time after the loss, as well as in the first year. It mostly contains universal information that will be helpful to anyone going through a loss. If you are a person who finds comfort in books or science, you will find comfort in this read. If you love someone who has recently lost a loved one, reading this will help you to know what behavior from them is normal and guide you in supporting them and validating them through the experience.

4 out of 5 stars

Source: Library

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The Neuroscience of Autism and Learning Disabilities (Science Librarian Boot Camp 2012 Tufts University)

Instead of inundating you with my notes from yet another professional development session, I decided to select out my favorite part to share with you all.  Out of everything I did in the Science Librarian Boot Camp, I enjoyed the Neuroscience presentations the most.  So, here they are. Enjoy!

“Genetics of Neurodevelopmental Disorders,” Dr. Anthony Moncao, Tufts University

  • Genetics studies Genes. Neurodevelopment studies Proteins and Regulatory DNA. Imagining studies the Brain.  Psychiatry studies Behavior.
  • Genes aren’t determinative.  They interact with the environment.
  • There is very strong evidence that genetic factors increase risk.
  • Susceptibility genes–genes that with environmental factors increase risk for these diseases
  • How do we find susceptibility genes?
  • Identify a chromosomal translocator and neurodevelopmental disorder.
  • Copy number variants –> Deletion or addition/duplication of material.  We all have these in some variation but in some instances they hit important areas.  They are inherited or de novo (neither parent had it).
  • What is “strict” Autism?
  • Impairment in: verbal and nonverbal communication, reciprocal social interaction, repetitive and stereotyped patterns of interest (don’t ilke change)
  • Onset before 3 years
  • male to female ratio: 4 to 1
  • Autism Spectrum includes Asperger Syndrome, PDD-NOS (removed from DSM5)
  • Autism Spectrum has a combined incidence of about 1%
  • 5% of Autism Spectrum disorders are comorbid with Fragile X, Tuberous Sclerosis, Down’s, muscular dystrophy, and other Mandelian disorders.
  • What are the genetic factors in Autism?
  • heritability is about 85 to 92%
  • rate among siblings is 3 to 9%
  • It is one of the most strongly genetic of childhood-onset psychiatric disorders.
  • No evidence yet for genes with variants in all forms of Autism.
  • Hardly any two autistic kids are gonna be the same (genetically).
  • Many of these genes are important in synapses.
  • Cadherin 8 (CDH8) is probably the culprit in these microdeletions.
  • Variable expressivity –> a deleted gene can cause multiple different outcomes (autsim, learning disorder, etc…) so evidence is strong environment is a factor
  • Future prospects include: Cohorts, sequencing, translation, use of rare CNVs diagnostically, genetic counseling, early intervention for sibs, CNVs may help us predict the outcome.
  • Projected future difficulties include: CNVs are common, so we have to be sure the one we’re calling Autism really is.  Ethical issues of testing children before they have any symptoms.
  • Autism has very complex etiology.
  • Collaboration is important to make progress.
  • Specific Language Impairment.
  • Just as frequent as dyslexia/autism.
  • It is a difficulty acquiring expressive and/or receptive language despite adequate intelligence and no physical problems (ie deafness).  Problems in producing and comprehending speech, problems reading, normal nonverbal IQs.
  • It has an almost 100% heritability.
  • Inheritance is simple but complex phenotype.
  • The damaged gene –> FOXP2
  • A transcription factor.
  • Important in how the rest of the gene is regulated.  Kind of like a master switch.
  • Not the gene for speech (found in nonverbal species but important in vocalizations.  Mice won’t squeak properly.  Songbirds can’t learn songs if it is damaged.)
  • FOXP2 inhibits CNTNAP2 from being expressed (Sitting on it and not letting it make RNA).
  • Where is FOXP2 expressed in the brain? In the basal ganglia, phallus, cerebellum (motor centers).
  • Chimps are more similar to mice than humans in this gene.
  • FOXP2 is a regulatory gene.  Its downstream targets offer entrypoints into neural pathways involved in speech and language.
  • Developmental Dyslexia.
  • It is a diagnosis of exclusion.
  • 5% of schoolchildren have it.
  • Males are 3 to 4 times more effected than females.
  • Gene variant is two times as frequent in dyslexics as in controls.
  • Variants in KIAA0319 repress the expression of the gene.
  • These variants increase risk in reading problems in the general population.
  • May inhibit migration of neurons to the right are of the cortex.
  • ectopia–small bundles of neurons in the wrong area of the cortex
  • 4 dyslexia susceptibility genes have been found so far.
  • All 4 play a role in neuronal migration and/or axonal growth.
  • DNA is not determinative.  There are many other factors involved.

“Neuroimaging of Children’s Brains,” Dr. Jean Frazier, UMass Med

  • Goal: To explore how neuroimaging techniques provide insight into potential biomarkers for childhood onset neuropsychiatric disorders.
  • Basic principles of brain development: structures start small, get big, then get small again
  • 8 to 14 is an important age range.
  • They exuberate then prune, and it is the pruning that is important.
  • The more complicated a process is the more potential it could go awry.
  • Pruning is guided by “use it or lose it.”
  • The exact timing varies by structure.
  • birth to 3–time of rapid intellectual, emotional, and physical growth of brain and brain wiring
  • by age 6–95% of brain development completed
  • 8 to 13–2nd major brain growth spurt
  • 13 to 20s–pruning to organizing, especially in frontal cortex.
  • We can measure things that require energy using: PET, SPECT, fMRI, EEG, MEG
  • What MRI can tell us: structure, metabolites, blood flow, connectivity
  • MRS–noninvasive, analytic method to measure chemicals within body parts
  • If we are going to fully appreciate what is going wrong in brains, we have to fully understand what is going right in brains.
  • Whereas gray matter gets pruned, white matter increases.
  • Less gray matter, brain becomes more efficient.
  • But what happens in atypical development?
  • More blood flow in amygdala of depressed and anxious.
  • amygdala–governs ability to modulate our affect
  • Bipolars have abnormal connectivity in brain, especially in areas dealing with affect regulation and attentional capacity.
  • Application to Autism?
  • Recommends “Localization of white matter volume increase in autism and developmental language disorder” in Annals of Neurology by Herbert et al
  • Children with autism have more white matter.
  • Tracks most severely affected in Autism are growing/changing just after birth.
  • Biomarkers are a distinct characteristic that is an indicator of a particular biological condition or process.
  • Maybe the genetic risk factors are indicators of the dysfunction not the disorder.
  • Both schizophrenia and autism symptom is social withdrawal.
  • 1 in 54 boys and 1 in 252 girls (1 in 88 children) have Autism Spectrum, according to study from 2008
  • Inhibition of GABA and excitation of Glutamate are associated with autism.
  • Tuberous make too little of a certain protein. Fragile X makes too much.
  • Glutamate levels are higher in Autism.
  • Biomarkers could be used as predictors for treatment response.

Book Review: Abject Relations: Everyday Worlds of Anorexia by Megan Warin

Woman standing in waterSummary:
Warin, an anthropologist, takes an entirely new approach to anorexia, looking it from a purely cultural and anthropological perspective.  She spends a couple of years interviewing women with anorexia at various points in the life of the illness from early treatment to recovery to relapse.  In this way she analyzes not just the culture of women and men suffering from anorexia but also how anorexia is a response to the culture these people find themselves in.

Review:
This was my first read from the holdings of my new workplace.  The instant I saw the title and book cover, I knew I needed to read it.  The anthropology of anorexia? How fascinating!

It’s interesting that I feel I actually learned a bit more about anthropology than anorexia from this book, but perhaps that is because I am more familiar with the latter than the former.  From my work in psychiatry and as a mental illness advocate, I was already aware that people suffering from anorexia have their own culture.  I still highly valued seeing this presented in an academic fashion with a respect for the people involved.  I commend Warin for her ability to interact with these women and glean a sense of how they came to be who they are now with a respect for them as people that is all too rare to see in this type of work.

So what of the anthropology then?  What are abject relations?  Over the course of the book I learned that abject relations are ambiguous relations.

What is abject is in between, ambiguous, and composite. Abjection is thus contrary to dualist concepts because it undermines and threatens that which is separate. As such, abjection is fundamentally concerned with the complexities and contradictions of relatedness. (page 184)

Whereas most books about eating disorders attempt to say THIS definitively caused it, this book’s premise is that the etiology is entirely ambiguous.  What caused it, what makes it persist, what it is to suffer from anorexia.  Nothing about it is clear-cut.  That is the powerful statement of the book.  There are no easy answers to anorexia, but we can do much more to understand it both as its own culture and as an aspect of our own.

This focus on anorexia as a response to the mainstream culture and a formation of a new culture leads Warin to question a lot of the inpatient treatment techniques.   Warin sees anorexia as frequently about women attempting to assert a right to control over their own bodies that goes horribly awry, ripping the control out of society’s or tormentor’s hands, into their own, into ana’s hands, then into the hands of an authority figure again at treatment.  Warin sees value in helping people suffering from anorexia recover in the context of society.  Instead of feeding them alone in a single room have them cook and eat together in a group.  This reenforces the cultural and connecting aspect of eating that they have been denying for so long.

It is an interesting idea to look at anorexia as an abject cultural response, but I don’t think it’s one that is quite as unique or revolutionary as Warin seems to think.  Whereas there have always been those who think anorexia is the ultimate kowtowing to what society deems feminine, there have also been those who view it as women protecting themselves from being perceived as feminine, from having unwanted interactions with those who would objectify them.  Perhaps it is really both, which is what makes it so hard to treat.  I believe this is what Warin is trying to say, although she is often not as clear as she could be.  She gets caught up in academic jargon.  She is at her strongest when simply organizing her interactions with the women into themes and presenting them to the reader to do with what they will.

Overall, for an academic look at anorexia this is unique in that it is an anthropological study instead of a psychiatric one.  Looking at a group of people who are a group simply because they share the same illness and studying their anthropology is a truly fascinating concept.  The book is scientific, but it is social science and is thus easy enough for the mainstream reader to follow.  It provides the human aspect of anorexia without sensationalizing.  Anyone with an interest in eating disorders or anthropology will enjoy this book.

4 out of 5 stars

Source: Work Library

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Book Review: The Creation of Psychopharmacology By David Healy

Summary:
A historical look at the emergence and development of psychopharmacology (psychiatric drugs) from the earliest time of psychiatry to the end of the 20th century.  Particular attention is paid to the impact psychiatric societies, economic systems, cultures, and drug companies have had on psychopharmacology.  Psychiatric drugs explored in-depth include chlorpromazine and SSRIs (Selective Serotonin Reuptake Inhibitors aka antidepressants).

Review:
I was quite excited to learn about the topic of this book, as psychopharmacology is one of the key aspects of psychiatric treatment.  It is therefore unfortunate that the author, Healy, allows his own biases to get in the way of presenting factual information.

The first portion of the book that discusses asylums and the original drugs discovered by scientists to work on psychoses does present the facts in an unbiased manner.  Unfortunately, Healy could not possibly write in a much more boring manner.  I have never in my life read a text that is so stale, and I do read scientific nonfiction for work on a fairly steady basis, so this is not a bias of my own against scientific writing.  The man just drones on and on.

The larger problem  arises in the second half of the book when Healy arrives in the 20th century.  Healy’s obvious anti-drug and anti-psychiatry bias emerges.  He flat-out gets facts wrong and displays paranoia, ranging from the typical conspiracy theory that the mental health community is in league with the drug companies to the more extreme idea that depression shouldn’t be treated because then there would be no more art or spirituality.  He also claims that personality disorders should not be treated, comparing such treatment to cosmetic surgery.  This claim is offensive and harmful to people who wish to become higher functioning, happier individuals.

Healy goes on to offer predictions as to the direction psychology and psychiatry will take in the 21st century.  Now that we are a decade in to that century, I can definitively tell you his predictions are wrong.  He argues that an increasing number of drugs will be used to remove most individuality and that therapy will continue to fall by the wayside.  In fact, the first decade of the 21st century saw a new movement toward CBT (Cognitive Behavioral Therapy) and DBT (Dialectical Behavioral Therapy), which are all about helping an individual change their harmful behaviors, thoughts, and tendencies purely through therapeutic techniques.  Healy is attempting to fear-monger his readers into believing psychiatry and psychology wish to drug us all up, when in fact the mental health community wants to use what works best in each situation.  Contrary to his claims, there are in fact biological bases for some mental health issues.

Although his facts are accurate in the earlier history of psychopharmacology, the second half of the book presents false facts and harmful ideas.  Due to this fact, I cannot recommend this book.  For an educated look at mental health and drugs, take a look at the DSMIV and the PDR.

1 out of 5 stars

Source: Library

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On Perfectionism

November 9, 2009 4 comments

Human beings are naturally fallible.  It’s one of the things that makes us humans and not a weird race of perfect angels running around the planet.  I accept this in others.  I expect them to make mistakes, and as long as they aren’t evil or huge, it’s no big deal.  But me?  Well, I expect myself to be perfect and when I inevitably fail, I beat myself up over it for hours. (This is a huge improvement over the old time-period of days).  I’m not talking huge mistakes that I should rightfully feel guilty about.  I’m talking about “oh I misunderstood what you were trying to say” or “oh this applesauce doesn’t quite taste perfect.”

Why do I do this unhealthy thing to myself?  With the insane amount of psychology/psychiatry reading I do in the course of my job, I have a theory.  Basically psychiatry believes people are born with a certain personality and every personality has weaknesses.  It’s the parents’ job to adpat their parenting technique to suit the child.  To uphold the strong parts of the personality and improve the weak parts.  This means there’s no one parenting technique that fits all.  Ok, I’m digressing a bit.

Essentially, I think that I was born with a natural tendency to be Type A.  You all know what that means.  Over-achieving. OCD. Etc…  Instead of telling me that I’m only human and can’t possibly be perfect though, I wound up with parents who were following one of the many versions of the Evangelical Christian faith.  I was told that since I was saved and had the Holy Spirit within me, not only should I naturally make fewer mistakes than those god-foresaken heathens out there, but also that I should strive every day to not sin.  Yes, mistakes were termed “sin.”

Sin just drips with this extra layer of connotation that’s not on a mistake.  A mistake is innocent.  Regrettable, but innocent.  Sin is letting demons into your life.  Sin is dripping with darkness and evil and everything that isn’t good in the world.  Sin is Satan breathing down your neck.  Sin makes God cry.

Ok, so a good little Christian girl isn’t supposed to sin as much as the heathens, and she should progressively sin less, but she *sigh* inevitably will.  So she should keep track of all her sins throughout the day and confess them individually in her evening prayers and beg for forgiveness.  But it’s not a real apology if you plan to ever do those things again, so if you ever commit that sin again, well that wasn’t a real apology was it?

Take one naturally Type A little girl, add these tenets, stir, and you get an adult Amanda who must constantly fight anxiety over not being perfect.

Yes, I know I left the religion that added to the Type A tendencies, so I should be doing much better than I am at not being so anxious about being perfect, but even when I let go of the Christian mores I was taught, my mistakes still carry that extra connotation.  My mistakes might not make god cry, but they could hurt people I care about.  My mistakes might not be dripping with demons and darkness, but they could put a damper on the evening.  And what if my mistakes build up so that they do cause problems in my life for me?  (Can you hear the panic attack starting in my head?)

Yes, I know it’s unrealistic and unhealthy to expect myself to be perfect.  And I know that I love the people in my life not only in spite of their faults, but because of them.  It just isn’t always easy to break the thought processes not only born into you but instilled in you.

So why am I blogging about this?  Because I doubt I’m the only person out there who holds herself to too high expectations, and I want those other perfectionists out there who might be reading this to know:  It’s not your fault you are a perfectionist.  Probably a lot of things had to combine to make you that way.  You don’t have to stay a perfectionist, and you also don’t have to be perfect.  People will love you just the way you are, so you should too.