Tagged Mental Health and Disorders

The Grizzly in the Purple Pants

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The Grizzly in the Purple Pants

My mom and stepdad wanted me to be more manly. In Cub Scouts, I just wanted to make the troop cupcakes.

Credit…Lucy Jones

  • Jan. 15, 2021, 5:00 a.m. ET

Russell Lee spat a wad of snuff into a Planters peanuts can. We sat at a picnic table in his backyard, next to the railroad tracks. He jackhammered the ground with his right leg.

“Your mom’s having an affair,” said Russ, my mother’s husband.

“What’re you talking about?” I stared at his face — grayed muttonchops against skin bronzed from working under the Texas sun. Hummingbirds buzzed past us, sucking sugar water from the cherry-red feeder. I wanted to crush them.

Russ struggled against tears. “And she has AIDS. I have proof.”

His accusation rang false, but adults held secrets. Then 21, I had mine.

I had met Russell Lee even before my mom did. When I was 5, my uncle took me to visit one of his ailing relatives. In walked a brawny guy carrying a motorcycle helmet and wearing purple pants. His thinning black hair was long and curly.

I wondered if he was a hippie. I’d seen ones on TV but never in real life.

When I was 6, my father, a suit-and-tie-wearing principal, descended into psychosis from abusing alcohol and speed. My mother, Nelda, a petite blonde schoolteacher, escaped with me when the death threats became body blows and a brandished .38.

Mom filed for divorce. The court forbade my father from future contact. We never saw him again.

Three months later, my mom’s sister arranged a blind date with one of her in-laws. He turned out to be Russell Lee, the man in the purple pants.

Mom loved that Russ had overcome life obstacles. One-quarter Cherokee, he was the last of 12 kids in an evangelical family of sharecroppers in the Ozarks. His mother died when he was 7. At 14, Russ quit middle school. He married four years later, had two kids, and by 45 had been divorced for a decade.

Within six weeks, he and my mom married. We moved from a middle-class life in conservative San Antonio to a duplex covered in psychedelic posters in liberal Austin.

My mother told me that Russ was my father now, so I should call him Dad.

I was a first grader and did as told but felt like a liar. Russell and I had met only four times.

He was an avid outdoorsman. I loved books and music. Scrawny, blond and asthmatic, I embodied my stepfather’s opposite, an albino salamander next to a grizzly bear.

Mom wanted me to be more like normal boys. She and her husband decided to remold me.

Cub Scouts was first. I kept offering to make the troop cupcakes.

They redoubled their efforts.

Every boy should know how to hunt and fish, Russ said. I wanted to play Scrabble, but he took me fishing. I threw the pole into the water. He had me shoot a rifle at a coffee can. I missed. “The only ones who’ll be safe are the deer,” he said, shaking his head.

Over time, the relationship with my stepdad became more contentious. Russ grew irate when I was elected student council president my junior year, saying the position interfered with my J.C. Penney janitor job.

He wanted me to quit, but I argued that the position might help me with college scholarships. Nelda and Russ had no money. I negotiated a compromise. “I won’t run again next year.”

But my plan was to run for senior class officer.

The next fall, we went to dinner at a relative’s house. Our hostess hugged me. “The ladies at church say you were elected class president. Congratulations!”

My stepdad smacked his fist against his thigh. “You promised me!” He didn’t look at me during the meal.

“You lied! Now you gotta quit,” he yelled, later in the car.

I startled myself when I said “no.”

He wanted me to move out, but my mother begged for me to be able to stay. I avoided him, going into their home just to sleep.

Each semester of high school, Russ insisted I take an auto repair class. I always stalled, promising “later.”

Every man should know how to work on his car, he said.

Before my last semester, Russell brought up the mechanics’ course again.

The only way I could fit it into my schedule was by dropping calculus, physics and AP English, so I refused.

“Don’t you disrespect—”

“I’m not meant for manual labor, like you!” I shouted. “I have a brain!”

“Get out.”

I stuffed my backpack.

“School ends soon. Let him stay until then,” mom pleaded.

Russ acquiesced, but skipped my graduation.

I moved out. When Russell and I saw each other at family events, we’d shake hands for show but keep our distance.

In my junior year of college, Russ was diagnosed with lung cancer. After he’d recovered from surgery, Nelda moved into a motel. My stepfather stayed at the house by the railroad tracks.

When my mom asked me to go see him, I agreed — as a favor to her.

It was during that visit he announced that my mother had AIDS, and that she had been cheating on him with the train engineers.

“When the horn blows, it’s a signal.” He believed my mother was meeting the railroad staff for trysts in a nearby abandoned shack.

“The tracks bend there,” I said, pointing. “The horns are warnings.”

He didn’t believe me. “There’s proof she has AIDS in the shack,” he said.

I crossed the tracks and went inside. “Nelda has AIDS” was spray-painted on a wall. But I recognized Russ’s handwriting. His capital “I” looked like a tadpole swallowing its tail.

When I called my mom, she cried. “He kept accusing me of grotesque sexual infidelity. I couldn’t take it.”

Because of our history of emotional distance, I wasn’t wounded by Russ’s break with reality. He’d been diagnosed with paranoid schizophrenia when I was in my teens. But mom hid the depth of his mental illness from me.

After his lung surgery, he’d stopped taking his meds. Mental illness made his greatest fear appear true: Nelda didn’t love him.

Witnessing the extent of his disorder made me kinder. I started visiting my stepdad on weekends. We convinced him to visit his psychiatrist, who recalibrated his medications. Nelda and Russ reconciled.

Though I’d come to understand him, it took me the better part of a decade to allow myself to trust him — and my mother — with my secret. At 30, I told them I was gay.

“Never made any difference to me,” Russ said.

My jaw hit the floor.

“He’s known since you were 16,” Nelda said. “A boy telephoned. Russ went to get you. You fainted.” I remembered the phone call, but hadn’t realized they did, too. A guy from Nebraska I had a crush on had called long-distance. We’d met at student council camp and I’d been desperate for him to like me.

She paused. “It was hard for me, but he says you were born this way.”

So, Russell Lee had been my secret ally all along.

When I was 45, he fractured a hip, had a heart attack and went into a coma. That night, the nurses told Nelda she had to leave. She hugged Russ. Though he was unconscious, his arm pulled her closer.

I flew back to Texas from New York. “There’s little chance for recovery,” a doctor said. We signed the papers to unplug the respirator.

The morning of his funeral, I walked outside. A hummingbird hovered near my face.

“If I could choose anyone in the world as my dad, I’d choose you,” I whispered. The tiny creature floated a moment longer. Then, it darted away.

Court Stroud lives in New York City, where he’s working on a book.

Some Covid Survivors Haunted by Loss of Smell and Taste

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Some Covid Survivors Haunted by Loss of Smell and Taste

As the coronavirus claims more victims, a once-rare diagnosis is receiving new attention from scientists, who fear it may affect nutrition and mental health.

Katherine Hansen used to be able to recreate a restaurant recipe just from tasting a dish. “I’m like someone who loses their eyesight as an adult,” she said.
Katherine Hansen used to be able to recreate a restaurant recipe just from tasting a dish. “I’m like someone who loses their eyesight as an adult,” she said.Credit…Jovelle Tamayo for The New York Times
Roni Caryn Rabin

  • Jan. 2, 2021, 10:26 a.m. ET

Until March, when everything started tasting like cardboard, Katherine Hansen had such a keen sense of smell that she could recreate almost any restaurant dish at home without the recipe, just by recalling the scents and flavors.

Then the coronavirus arrived. One of Ms. Hansen’s first symptoms was a loss of smell, and then of taste. Ms. Hansen still cannot taste food, and says she can’t even tolerate chewing it. Now she lives mostly on soups and shakes.

“I’m like someone who loses their eyesight as an adult,” said Ms. Hansen, a realtor who lives outside Seattle. “They know what something should look like. I know what it should taste like, but I can’t get there.”

A diminished sense of smell, called anosmia, has emerged as one of the telltale symptoms of Covid-19, the illness caused by the coronavirus. It is the first symptom for some patients, and sometimes the only one. Often accompanied by an inability to taste, anosmia occurs abruptly and dramatically in these patients, almost as if a switch had been flipped.

Most regain their senses of smell and taste after they recover, usually within weeks. But in a minority of patients like Ms. Hansen, the loss persists, and doctors cannot say when or if the senses will return.

Scientists know little about how the virus causes persistent anosmia or how to cure it. But cases are piling up as the coronavirus sweeps across the world, and some experts fear that the pandemic may leave huge numbers of people with a permanent loss of smell and taste. The prospect has set off an urgent scramble among researchers to learn more about why patients are losing these essential senses, and how to help them.

“Many people have been doing olfactory research for decades and getting little attention,” said Dr. Dolores Malaspina, professor of psychiatry, neuroscience, genetics and genomics at Icahn School of Medicine at Mount Sinai in New York. “Covid is just turning that field upside down.”

Smell is intimately tied to both taste and appetite, and anosmia often robs people of the pleasure of eating. But the sudden absence also may have a profound impact on mood and quality of life.

Studies have linked anosmia to social isolation and anhedonia, an inability to feel pleasure, as well as a strange sense of detachment and isolation. Memories and emotions are intricately tied to smell, and the olfactory system plays an important though largely unrecognized role in emotional well-being, said Dr. Sandeep Robert Datta, an associate professor of neurobiology at Harvard Medical School.

“You think of it as an aesthetic bonus sense,” Dr. Datta said. “But when someone is denied their sense of smell, it changes the way they perceive the environment and their place in the environment. People’s sense of well-being declines. It can be really jarring and disconcerting.”

Many sufferers describe the loss as extremely upsetting, even debilitating, all the more so because it is invisible to others.

“Smell is not something we pay a lot of attention to until it’s gone,” said Pamela Dalton, who studies smell’s link to cognition and emotion at the Monell Chemical Senses Center in Philadelphia. “Then people notice it, and it is pretty distressing. Nothing is quite the same.”

British scientists studied the experiences of 9,000 Covid-19 patients who joined a Facebook support group set up by the charity group AbScent between March 24 and September 30. Many members said they had not only lost pleasure in eating, but also in socializing. The loss had weakened their bonds with other people, affecting intimate relationships and leaving them feeling isolated, even detached from reality.

“I feel alien from myself,” one participant wrote. “It’s also kind of a loneliness in the world. Like a part of me is missing, as I can no longer smell and experience the emotions of everyday basic living.”

Another said, “I feel discombobulated — like I don’t exist. I can’t smell my house and feel at home. I can’t smell fresh air or grass when I go out. I can’t smell the rain.”

Loss of smell is a risk factor for anxiety and depression, so the implications of widespread anosmia deeply trouble mental health experts. Dr. Malaspina and other researchers have found that olfactory dysfunction often precedes social deficits in schizophrenia, and social withdrawal even in healthy individuals.

“From a public health perspective, this is really important,” Dr. Datta said. “If you think worldwide about the number of people with Covid, even if only 10 percent have a more prolonged smell loss, we’re talking about potentially millions of people.”

The most immediate effects may be nutritional. People with anosmia may continue to perceive basic tastes — salty, sour, sweet, bitter and umami. But taste buds are relatively crude preceptors. Smell adds complexity to the perception of flavor via hundreds of odor receptors signaling the brain.

Many people who can’t smell will lose their appetites, putting them at risk of nutritional deficits and unintended weight loss. Kara VanGuilder, who lives in Brookline, Mass., said she has lost 20 pounds since March, when her sense of smell vanished.

“I call it the Covid diet,” said Ms. VanGuilder, 26, who works in medical administration. “There no point in indulging in brownies if I can’t really taste the brownie.”

But while she jokes about it, she added, the loss has been distressing: “For a few months, every day almost, I would cry at the end of the day.”

Michele Miller developed anosmia following a bout with Covid-19 in March. She did not smell the gas from the oven filling up her kitchen.
Michele Miller developed anosmia following a bout with Covid-19 in March. She did not smell the gas from the oven filling up her kitchen.Credit…Joshua Bright for The New York Times

Smells also serve as a primal alarm system alerting humans to dangers in our environment, like fires or gas leaks. A diminished sense of smell in old age is one reason older individuals are more prone to accidents, like fires caused by leaving burning food on the stove.

Michele Miller, of Bayside, N.Y., was infected with the coronavirus in March and hasn’t smelled anything since then. Recently, her husband and daughter rushed her out of their house, saying the kitchen was filling with gas.

She had no idea. “It’s one thing not to smell and taste, but this is survival,” Ms. Miller said.

Humans constantly scan their environments for smells that signal changes and potential harms, though the process is not always conscious, said Dr. Dalton, of the Monell Chemical Senses Center.

Smell alerts the brain to the mundane, like dirty clothes, and the risky, like spoiled food. Without this form of detection, “people get anxious about things,” Dr. Dalton said.

Even worse, some Covid-19 survivors are tormented by phantom odors that are unpleasant and often noxious, like the smells of burning plastic, ammonia or feces, a distortion called parosmia.

Eric Reynolds, a 51-year-old probation officer in Santa Maria, Calif., lost his sense of smell when he contracted Covid-19 in April. Now, he said, he often perceives foul odors that he knows don’t exist. Diet drinks taste like dirt; soap and laundry detergent smell like stagnant water or ammonia.

“I can’t do dishes, it makes me gag,” Mr. Reynolds said. He’s also haunted by phantom smells of corn chips and a scent he calls “old lady perfume smell.”

It’s not unusual for patients like him to develop food aversions related to their distorted perceptions, said Dr. Evan R. Reiter, medical director of the smell and taste center at Virginia Commonwealth University, who has been tracking the recovery of some 2,000 Covid-19 patients who lost their sense of smell.

One of his patients is recovering, but “now that it’s coming back, she’s saying that everything or virtually everything that she eats will give her a gasoline taste or smell,” Dr. Reiter said.

The derangement of smell may be part of the recovery process, as receptors in the nose struggle to reawaken, sending signals to the brain that misfire or are misread, Dr. Reiter said.

After loss of smell, “different populations or subtypes of receptors may be impacted to different degrees, so the signals your brain is used to getting when you eat steak will be distorted and may trick your brain into thinking you’re eating dog poop or something else that’s not palatable.”

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Patients desperate for answers and treatment have tried therapies like smell training: sniffing essential oils or sachets with a variety of odors — such as lavender, eucalyptus, cinnamon and chocolate — several times a day in an effort to coax back the sense of smell. A recent study of 153 patients in Germany found the training could be moderately helpful in those who had lower olfactory functioning and in those with parosmia.

Dr. Alfred Iloreta, an otolaryngologist at Mount Sinai Hospital in New York, has begun a clinical trial to see whether taking fish oil helps restore the sense of smell. The omega-3 fatty acids found in fish oil may protect nerve cells from further damage or help regenerate nerve growth, he suggested.

“If you have no smell or taste, you have a hard time eating anything, and that’s a massive quality of life issue,” Dr. Iloreta said. “My patients, and the people I know who have lost their smell, are completely wrecked by it.”

Mr. Reynolds feels the loss most acutely when he goes to the beach near his home to walk. He no longer smells the ocean or salt air.

“My mind knows what it smells like,” he said. “And when I get there, it’s not there.”

For a Healthier 2021, Keep the Best Habits of a Very Bad Year

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For a Healthier 2021, Keep the Best Habits of a Very Bad Year

Our 7-Day Well Challenge will show you how to build on the healthy habits you learned during pandemic life.

Credit…Andrew B Myers
Tara Parker-Pope

  • Jan. 1, 2021, 5:00 a.m. ET

Here’s a better way to start the new year: Skip the traditional January resolutions and make time for some New Year’s reflection instead.

Take a moment to look back on the past 365 days of your life. Years from now, when you talk about 2020, what stories will you tell? Will it be clapping for health care workers every night at 7 p.m.? Or perhaps it will be a memory from the months spent mostly at home with family members — or the pandemic “bubbles” you formed that helped friendships grow stronger. Maybe you will tell the story of losing someone you loved or remember finding strength and resilience you didn’t know you had.

While reliving much of 2020 may sound like a terrible idea, psychologists say it’s a better way to start the new year. Looking back will help you build on the lessons you learned, and you may even discover some hidden positive habits you didn’t realize you had started.

“I don’t think we’ve given ourselves enough credit,” said Kelly McGonigal, a health psychologist and lecturer at Stanford University and author of “The Willpower Instinct.” “I don’t think we have had the emotional appreciation that we need and deserve for the kind of year many people have had. The reflection that’s needed right now is a real, honest and self-compassionate look at what’s been lost, who’s been lost and what it is that you want to choose to remember about 2020. Reflection is a way of being ready to move forward into the new year. I say that every year, but I think that it’s especially true for this year.”

Reflections vs. Resolutions

Reflecting on what you accomplished in 2020 — and what you missed or lost — is also a healthier path toward self-improvement than the typical New Year’s resolution. Studies consistently show that New Year’s resolutions don’t work. By February, most people have abandoned them.

The problem with many resolutions is that they tend to be inherently self-critical and stem from a sort of magical thinking that with one big change — some weight loss, regular exercise, more money — life will be transformed. “It’s just too easy to look for a behavior that you regularly criticize yourself for, or feel guilty about,” Dr. McGonigal said. “It’s that false promise of, ‘If you change this one thing, you’ll change everything.’”

Studies show that one of the best ways to change behavior and form a new habit is to bundle it with an existing behavior — what in the science of habit formation is called “stacking.” It’s the reason doctors, for example, suggest taking a new medication at the same time you brush your teeth or have your morning coffee: You’re more likely to remember to take your pill when you piggyback it onto an existing habit. Adding steps to your daily commute often is a better way to add exercise to your day than trying to carve out a separate time for a daily walk.

By reflecting on the lessons of the past year, we can stack and build on the good habits we started in 2020. Maybe that involved figuring out new ways to exercise when gyms were closed, strengthening friendships forged through our social bubbles, organizing our homes for 24-7 living and learning, learning to cook healthier meals or making ourselves accountable for the care of others.

Now, with the distribution of vaccines and the end to the pandemic in sight, you don’t need to abandon those changes — instead, try building on them. The first challenge is listed below. Then, starting Monday and every day next week, the 7-Day Well Challenge will identify a popular quarantine habit and offer a new strategy for turning it into a healthy lifelong habit. Just sign up for the Well newsletter, and you’ll receive a daily email reminder to join that day’s challenge.

Day 1

Build on Your Gratitude Habit

Credit…Andrew B Myers

Quarantine clapping became a nightly ritual in many parts of the United States and around the world as a collective thanks to health care workers. It was both a show of community and a show of gratitude. The experience was what sociologists call “collective effervescence,” which happens when people simultaneously come together and take part in a group ritual.

Clapping for essential workers had the effect of “both unifying and energizing the group for action toward a common cause, such as persevering through the pandemic,” said Joshua W. Brown, professor in the department of psychological and brain sciences at Indiana University Bloomington. “Group expressions of gratitude can be empowering for both those expressing it and those receiving it.”

Perhaps you showed gratitude in other ways. Did you offer larger tips than usual to delivery and restaurant workers? Did you find yourself saying a heartfelt thank you to the grocery and pharmacy workers at checkout? When things got tough at home, did you remind yourself and your children of all the things for which you felt grateful? I adopted a regular gratitude hand-washing ritual, thinking of 10 things to be grateful for — one for every finger I washed.

Why it matters: Numerous studies show that people who have a daily gratitude practice, in which they consciously count their blessings, tend to be happier, have lower stress levels, sleep better and are less likely to experience depression. In one study, researchers recruited 300 adults, most of them college students seeking mental health counseling. All the volunteers received counseling, but one group added a writing exercise focused on bad experiences, while another group wrote a letter of gratitude to another person each week for three weeks. A month later, those who wrote gratitude letters reported significantly better mental health. And the effect appears to last. Three months later the researchers scanned the brains of students while they completed a different gratitude exercise. The students who had written gratitude letters earlier in the study showed greater activation in a part of the brain called the medial prefrontal cortex, believed to be related to both reward and higher-level cognition.

Take the Gratitude Challenge

This week, try one or more of these simple gratitude exercises.

Start small. Send an appreciative email or text, thank a service worker or tell your children, your spouse or a friend how they have made your life better. “A great way to develop more gratitude would be regular small steps — an extra email or note of appreciation to a colleague, or an extra in-person thank-you, and a focus on how rewarding it is to brighten someone’s day with appreciation,” Dr. Brown said.

Create a gratitude reminder. Dr. McGonigal keeps a sticky note on her desk lamp that reads:

1. Someone
2. Something
3. Yourself

It’s a daily reminder to express gratitude not only for the people, events and gifts in her life but also for her own accomplishments. She might feel gratitude for completing a workout, for a healthy body or for taking on a new challenge. “Gratitude is really good when what you need is a belief in your ability to create a more positive future and a willingness to trust others to help you do that,” Dr. McGonigal said. “And that feels like a really good mind-set for right now.”

Express your gratitude in writing. You can send emails or post feelings of gratitude on social media or in a group chat. Or think of someone in your life and write them a letter of gratitude. (You don’t have to mail it.) Fill your letter with details describing how this person influenced your life and the things you appreciate about them. Or keep a daily gratitude journal.

“I think the full potential of gratitude is realized when people are able to express gratitude in words,” says Y. Joel Wong, chairman of the department of counseling and educational psychology at Indiana University. “When we are able to say what we’re grateful for and explain why, it shifts our attention from what’s negative to what’s positive in our lives.”

Sign up for the Well newsletter to receive the next Well challenge in your inbox.

How to Stay Connected and Fend Off Loneliness in the New Year

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How to Stay Connected and Fend Off Loneliness in the New Year

As we head into 2021, here is some advice from Well on how to replace loneliness with opportunities for connection.

Cinemagraph
CreditCredit…By Till Lauer

  • Dec. 30, 2020, 5:00 a.m. ET

This pandemic year has left too many of us feeling isolated and lonely. As we head into 2021, here is some advice from Well on how to replace loneliness with opportunities for connection.

How to Combat Pandemic Loneliness

By Emily Sohn

After months of lockdowns and shelter-in-place orders, some experts worry about a rise in the number of people feeling alone, especially young people and older adults. But resilience is also widespread, and studying loneliness can reveal a variety of ways to combat it.

“In light of the pandemic, there are ways that we can increase that sense of connection or reduce feelings of loneliness in ways that we may be able to do safely at a distance,” said Julianne Holt-Lunstad, a professor of psychology and neuroscience at Brigham Young University. “One of the things that research has shown is that social support is incredibly helpful in times of stress.”

How to Meet New People, Even at a Distance

By Julia Hotz

A retired teacher, a Midwestern minister and a mother of two teenagers all dial into a Zoom room. For the next 90 minutes, they do something their typical adult lives don’t usually afford them a chance to do: listen to others’ perspectives, and have others listen to them. And after three rounds of answering not-so-standard questions, like “What sense of purpose guides you in your life?”, the group leaves the room, feeling deeply connected.

Or so goes the logic of “Living Room Conversations” — an online platform through which volunteer hosts help small groups of people discuss timely topics such as voting, gun rights and their vision for America. Founded in 2010 by two women on differing sides of the political spectrum, with the input of dialogue experts, Living Room Conversations have sought to show how people could have civil conversations across lines of difference. At one point, these discussions, which have always been free to join, happened in actual living rooms. But when the coronavirus mandated a strict lockdown, the conversations went online-only, and became a means for alleviating loneliness, too.

Take Steps to Counter the Loneliness of Social Distancing

By Jane E. Brody

Two years ago, when Dr. Vivek H. Murthy, the former surgeon general of the United States, started researching his book, “Together: The Healing Power of Human Connection in a Sometimes Lonely World,” he never anticipated how relevant the topic would be now that it is about to be published.

The coronavirus pandemic and resulting advice — stay home if at all possible, avoid convening with others and refrain from close contacts even on the street — has intensified the harm inflicted by factors that already isolate people and rendered many of the antidotes to isolation moot.

The Double Whammy of Seasonal Affective Disorder in a Season of Covid

By Jane E. Brody

It’s challenging to maintain joie de vivre when there are limited opportunities to socialize with people who can lift one’s spirits or to attend cultural or sports events that break up the monotony of pandemic days and nights.

But while the pandemic, with its myriad economic, vocational, educational and social disruptions, is challenge enough for people who are not normally prone to the blues, the days of truncated daylight this November through March could be far gloomier than usual for millions of Americans who suffer annually from seasonal depression.

Small Number of Covid Patients Develop Severe Psychotic Symptoms

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Small Number of Covid Patients Develop Severe Psychotic Symptoms

Most had no history of mental illness and became psychotic weeks after contracting the virus. Cases are expected to remain rare but are being reported worldwide.

Dr. Hisam Goueli treated several psychotic patients who had never had mental health issues before, including a woman who told him she kept visualizing her children being murdered. “It was like she was experiencing a movie,” he said.
Dr. Hisam Goueli treated several psychotic patients who had never had mental health issues before, including a woman who told him she kept visualizing her children being murdered. “It was like she was experiencing a movie,” he said.Credit…Jovelle Tamayo for The New York Times
Pam Belluck

  • Dec. 28, 2020, 12:03 p.m. ET

Almost immediately, Dr. Hisam Goueli could tell that the patient who came to his psychiatric hospital on Long Island this summer was unusual.

The patient, a 42-year-old physical therapist and mother of four young children, had never had psychiatric symptoms or any family history of mental illness. Yet there she was, sitting at a table in a beige-walled room at South Oaks Hospital in Amityville, N.Y., sobbing and saying that she kept seeing her children, ages 2 to 10, being gruesomely murdered and that she herself had crafted plans to kill them.

“It was like she was experiencing a movie, like ‘Kill Bill,’” Dr. Goueli, a psychiatrist, said.

The patient described one of her children being run over by a truck and another decapitated. “It’s a horrifying thing that here’s this well-accomplished woman and she’s like ‘I love my kids, and I don’t know why I feel this way that I want to decapitate them,’” he said.

The only notable thing about her medical history was that the woman, who declined to be interviewed but allowed Dr. Goueli to describe her case, had become infected with the coronavirus in the spring. She had experienced only mild physical symptoms from the virus, but, months later, she heard a voice that first told her to kill herself and then told her to kill her children.

At South Oaks, which has an inpatient psychiatric treatment program for Covid-19 patients, Dr. Goueli was unsure whether the coronavirus was connected to the woman’s psychological symptoms. “Maybe this is Covid-related, maybe it’s not,” he recalled thinking.

“But then,” he said, “we saw a second case, a third case and a fourth case, and we’re like ‘There’s something happening.’”

Indeed, doctors are reporting similar cases across the country and around the world. A small number of Covid patients who had never experienced mental health problems are developing severe psychotic symptoms weeks after contracting the coronavirus.

In interviews and scientific articles, doctors described:

A 36-year-old nursing home employee in North Carolina who became so paranoid that she believed her three children would be kidnapped and, to save them, tried to pass them through a fast-food restaurant’s drive-through window.

A 30-year-old construction worker in New York City who became so delusional that he imagined his cousin was going to murder him, and, to protect himself, he tried to strangle his cousin in bed.

A 55-year-old woman in Britain had hallucinations of monkeys and a lion and became convinced a family member had been replaced by an impostor.

Beyond individual reports, a British study of neurological or psychiatric complications in 153 patients hospitalized with Covid-19 found that 10 people had “new-onset psychosis.” Another study identified 10 such patients in one hospital in Spain. And in Covid-related social media groups, medical professionals discuss seeing patients with similar symptoms in the Midwest, Great Plains and elsewhere.

“My guess is any place that is seeing Covid is probably seeing this,” said Dr. Colin Smith at Duke University Medical Center in Durham, who helped treat the North Carolina woman. He and other doctors said their patients were too fragile to be asked whether they wanted to be interviewed for this article, but some, including the North Carolina woman, agreed to have their cases described in scientific papers.

Medical experts say they expect that such extreme psychiatric dysfunction will affect only a small proportion of patients. But the cases are considered examples of another way the Covid-19 disease process can affect mental health and brain function.

Although the coronavirus was initially thought primarily to cause respiratory distress, there is now ample evidence of many other symptoms, including neurological, cognitive and psychological effects, that could emerge even in patients who didn’t develop serious lung, heart or circulatory problems. Such symptoms can be just as debilitating to a person’s ability to function and work, and it’s often unclear how long they will last or how to treat them.

Experts increasingly believe brain-related effects may be linked to the body’s immune system response to the coronavirus and possibly to vascular problems or surges of inflammation caused by the disease process.

“Some of the neurotoxins that are reactions to immune activation can go to the brain, through the blood-brain barrier, and can induce this damage,” said Dr. Vilma Gabbay, a co-director of the Psychiatry Research Institute at Montefiore Einstein in the Bronx.

Brain scans, spinal fluid analyses and other tests didn’t find any brain infection, said Dr. Gabbay, whose hospital has treated two patients with post-Covid psychosis: a 49-year-old man who heard voices and believed he was the devil and a 34-year-old woman who began carrying a knife, disrobing in front of strangers and putting hand sanitizer in her food.

Physically, most of these patients didn’t get very sick from Covid-19, reports indicate. The patients that Dr. Goueli treated experienced no respiratory problems, but they did have subtle neurological symptoms like hand tingling, vertigo, headaches or diminished smell. Then, two weeks to several months later, he said, they “develop this profound psychosis, which is really dangerous and scary to all of the people around them.”

Also striking is that most patients have been in their 30s, 40s and 50s. “It’s very rare for you to develop this type of psychosis in this age range,” Dr. Goueli said, since such symptoms more typically accompany schizophrenia in young people or dementia in older patients. And some patients — like the physical therapist who took herself to the hospital — understood something was wrong, while usually “people with psychosis don’t have an insight that they’ve lost touch with reality.”

Some post-Covid patients who developed psychosis needed weeks of hospitalization in which doctors tried different medications before finding one that helped.

Dr. Robert Yolken, a neurovirology expert at Johns Hopkins University School of Medicine in Baltimore, said that although people might recover physically from Covid-19, in some cases their immune systems, might be unable to shut down or might remain engaged because of “delayed clearance of a small amount of virus.”

Persistent immune activation is also a leading explanation for brain fog and memory problems bedeviling many Covid survivors, and Emily Severance, a schizophrenia expert at Johns Hopkins, said post-Covid cognitive and psychiatric effects might result from “something similar happening in the brain.”

It may hinge on which brain region the immune response affects, Dr. Yolken said, adding, “some people have neurological symptoms, some people psychiatric and many people have a combination.”

From left, Drs. Jonathan Komisar, Brian Kincaid and Colin Smith of Duke University Medical Center, who treated a woman whose sudden psychosis made her paranoid that her children were about to be kidnapped and that cellphones were tracking her.
From left, Drs. Jonathan Komisar, Brian Kincaid and Colin Smith of Duke University Medical Center, who treated a woman whose sudden psychosis made her paranoid that her children were about to be kidnapped and that cellphones were tracking her.Credit…Jeremy M. Lange for The New York Times

Experts don’t know whether genetic makeup or perhaps an undetected predisposition for psychiatric illness put some people at greater risk. Dr. Brian Kincaid, medical director of psychiatric emergency department services at Duke, said the North Carolina woman once had a skin reaction to another virus, which might suggest her immune system responds zealously to viral infections.

Sporadic cases of post-infectious psychosis and mania have occurred with other viruses, including the 1918 flu and the coronaviruses SARS and MERS.

“We think that it’s not unique to Covid,” said Dr. Jonathan Alpert, chairman of psychiatry and behavioral sciences at Albert Einstein College of Medicine, who co-wrote the report on the Montefiore patients. He said studying these cases might help to increase doctors’ understanding of psychosis.

The symptoms have ranged widely, some surprisingly severe for a first psychotic episode, experts said. Dr. Goueli said a 46-year-old pharmacy technician, whose family brought her in after she became fearful that evil spirits had invaded her home, “cried literally for four days” in the hospital.

He said the 30-year-old construction worker, brought to the hospital by the police, became “extremely violent,” dismantling a hospital radiator and using its parts and his shoes to try to break out of a window. He also swung a chair at hospital staff.

How long the psychosis lasted and patients’ response to treatment has varied. The woman in Britain — whose symptoms included paranoia about the color red and terror that nurses were devils who would harm her and a family member — took about 40 days to recover, according to a case report.

The 49-year-old man treated at Montefiore was discharged after several weeks’ hospitalization, but “he was still struggling two months out” and required readmission, Dr. Gabbay said.

The North Carolina woman, who was convinced that cellphones were tracking her and that her partner would steal her pandemic stimulus money, didn’t improve with the first medication, said Dr. Jonathan Komisar at Duke, who said doctors initially thought her symptoms reflected bipolar disorder. “When we began to realize that maybe this isn’t going resolve immediately,” he said, she was given an antipsychotic, risperidone and discharged in a week.

The physical therapist who planned to murder her children had more difficulty. “Every day, she was getting worse,” Dr. Goueli said. “We tried probably eight different medicines,” including antidepressants, antipsychotics and lithium. “She was so ill that we were considering electroconvulsive therapy for her because nothing was working.”

About two weeks into her hospitalization, she couldn’t remember what her 2-year-old looked like. Calls with family were heartbreaking because “‘You could hear one in the background saying ‘When is Mom coming home?’” Dr. Goueli said. “That brought her a lot of shame because she was like, ‘I can’t be around my kids and here they are loving me.’”

Ultimately, risperidone proved effective and after four weeks, she returned home to her family, “95 percent perfect,” he said.

“We don’t know what the natural course of this is,” Dr. Goueli said. “Does this eventually go away? Do people get better? How long does that normally take? And are you then more prone to have other psychiatric issues as a result? There are just so many unanswered questions.”

Soothing Anxiety and Stress: Advice From the Year in Well

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Soothing Anxiety and Stress: Advice From the Year in Well

Exercise, new news habits, even dipping your face into an icy plunge pool are among the steps you can take for a mellower new year.

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CreditCredit…By Till Lauer

  • Dec. 28, 2020, 5:00 a.m. ET

For many of us, 2020 was an exceptionally stressful year, dominated by fears about the coronavirus pandemic. Even with the vaccine on the horizon, we’re likely to need some stress management strategies to carry us into 2021. There’s lots of advice in this guide by Tara Parker-Pope, How to Be Better at Stress. Stress doesn’t have to get you down, she writes: “Approach it the right way, and it won’t rule your life — it can even be good for you. Here are ways to deal with stress, reduce its harm and even use your daily stress to make you stronger.”

Following are more tips from the past year’s stories by Well writers.

In Stressful Times, Make Stress Work for You

By Kari Leibowitz and Alia Crum

These are stressful times. As a result of coronavirus and the disease it causes, Covid-19, millions of Americans aren’t just worried about their health, but also about their livelihoods and their futures. At the same time, warnings abound that stress itself is bad for our health and might even make us more susceptible to the illness. The irony is obvious.

Fortunately, there is an alternative approach: We can actually use that stress to improve our health and well-being. Over a decade of research — ours and that of others — suggests that it’s not the type or amount of stress that determines its impact. Instead, it’s our mind-set about stress that matters most.

Exercise May Make It Easier to Bounce Back From Stress

By Gretchen Reynolds

Exercise makes it easier to bounce back from too much stress, according to a fascinating new study with mice. It finds that regular exercise increases the levels of a chemical in the animals’ brains that helps them remain psychologically resilient and plucky, even when their lives seem suddenly strange, intimidating and filled with threats.

The study involved mice, but it is likely to have implications for our species, too, as we face the stress and discombobulation of the ongoing pandemic and today’s political and social disruptions.

Five-Minute Coronavirus Stress Resets

By Jenny Taitz

Rather than dealing with anxiety and uncertainty by getting lost worrying, then chasing short-term fixes with longer-term consequences, like procrastinating, using food or marijuana to cope or relying on benzodiazepines — the anti-anxiety drugs like Xanax — it’s helpful to experiment with quick strategies that will empower you. These strategies are not necessarily a cure, but can help lower the intensity of overwhelming emotions, allowing you to recalibrate to better deal with challenges you face.

My patients often reflect that an additional perk of strategic coping is boosting your sense of mastery — the hope that arises when you stretch yourself and accomplish something difficult, like coping with your anxiety in a productive way.

Managing Coronavirus Fears

By Jane E. Brody

Covid-19, the invisible enemy now bearing down on 328.2 million Americans, is tailor-made to induce fear and anxiety, prompting both rational and irrational behavior and, if the emotional stress persists, perhaps causing long-lasting harm to health.

A psychotherapist I know has advised his patients to limit their exposure to the news and discussions about Covid-19 to one hour a day and, if possible, in only one location, then use the rest of the day and other parts of the home for productive or pleasurable activities.

Helping Children With Anxiety in the Pandemic

By Perri Klass, M.D.

Yes, this is an anxious time, and yes, everyone is anxious, but it is particularly hard to be an anxious kid in an anxious time. Anxiety disorders are the most common mental health disorders in children and adolescents (and this was true before the pandemic), and they can be linked to other mental health issues, notably depression.

Anxiety can bring children into emergency rooms, and into psychiatric hospitalizations, and in a time of generally heightened stress and anxiety, parents with anxious kids find themselves worrying especially about the worriers, wondering how to talk with them about the complexities of life in 2020, and trying to assess when worry is, well, worrisome enough to need professional help.

Depression in Childhood Tied to Physical Illnesses in Young Adulthood

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Depression in Childhood Tied to Physical Illnesses in Young Adulthood

Youths with depression had elevated risks of liver disease, thyroid illness and other problems in their 20s.

Nicholas Bakalar

  • Dec. 14, 2020, 5:15 p.m. ET

Children and adolescents diagnosed with depression may be at increased risk for physical diseases and premature death as young adults, researchers report.

For a study published in JAMA Psychiatry, researchers used Swedish health registries to track a group of 1,487,964 children, of whom 37,185 were diagnosed with depression between ages 5 and 19. The investigators followed the group until they ranged in age from 17 to 31.

Of 69 physical diseases they were able to track, people with depression had a higher risk for 66 of them, even after controlling for other psychiatric illnesses.

For example, compared to their peers who were not depressed, they had eight times the risk of sleep disorders, more than three times the risk of liver disease, and nearly five times the risk of thyroid illness.

Boys had higher risks than girls for most diseases, but both boys and girls with depression had a rate of all-cause mortality six times as high as those without depression. Their rate of suicide was 14 times as high, and deaths from natural causes more than twice as high, as their peers who were not depressed.

“Our observational study can’t address whether this is causal,” said the lead author, Marica Leone, a Ph.D. student at the Karolinska Institute in Stockholm. “We need further research to determine that. But physicians need to look for other diseases, and not just psychiatric disorders, that flow from youth depression.”

A Rare Pandemic Silver Lining: Mental Health Start-Ups

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A Rare Pandemic Silver Lining: Mental Health Start-Ups

Using teletherapy, metrics and matching algorithms, entrepreneurs are focusing on addressing aspects of the mental health care system that they view as broken.

Credit…Romy Blümel

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  • Dec. 7, 2020, 5:00 a.m. ET

Ariela Safira was on a mission. Shaken by the attempted suicide of a friend during her freshman year at Stanford University in 2013, Ms. Safira sought to understand the opaque mental health care system. She soon learned of the shortage of qualified therapists and, even where they are more plentiful, of the hurdles to obtaining care. Although a computer science and math major, she eventually enrolled in a clinical psychology graduate program at Columbia University.

But she kept coming back to a fundamental view: that there is often a mismatch between need and services, an essential supply-and-demand question. “It’s very difficult to start and keep up a therapy business,” Ms. Safira said. “It’s a 10-person job, not a one-person job, from marketing yourself, doing your own financing and managing your own rent. But even before you get to a place where you manage all those things, what’s so challenging is making a name for yourself so that people want to go to you.”

And so, in 2019, she founded Real Therapy, a small business designed to tackle mental health and overall wellness by easing access and offering a range of services to answer clients’ needs.

Driven by personal experience — and further motivated by the pandemic, which has caused an increase in anxiety and depression among the general population, including among young adults — entrepreneurs like Ms. Safira are focusing on addressing aspects of the mental health care system that they view as broken. They seem undeterred by the complicated nature of that system: a byzantine insurance process, a wide range of provider types, and elusive fits between patient and therapist.

“It’s a crowded space,” Alex Katz, the founder of Two Chairs, which opened its doors with a single clinic in San Francisco in 2017, said of the mental health start-up scene. Nonetheless, he said, “because the problems are massive, we need a lot of great companies working in innovative ways to address the different populations, diagnoses and delivery of care.”

Mr. Katz, another Stanford graduate, began working at Palantir, the data analytics and software company, but sought to understand mental health services when his partner “was going through a tough time in her life.” He eventually quit his job and began to tap into his network of friends and family to understand the mental health care system.

He soon learned that one of the system’s biggest challenges was matching a therapist with a patient, something he thought technology could solve. Yet, after interviewing clinicians, he chose to start a physical clinic, rather than a virtual one. In trying to raise funds for his fledgling business, “I joke that I had three strikes against me: I was a first-time, solo founder of a bricks-and-mortar company in health care.” But from its inception, Two Chairs has relied on technology, using a frequently updated proprietary algorithm to match client and therapist after a prospective client’s first intake meeting.

Although both Ms. Safira and Mr. Katz initially focused on in-person care, with virtual therapy as a long-term goal, they had no choice but to change direction once the pandemic hit. Ms. Safira and her small team quickly had to shift from the Manhattan space they carefully designed and renovated, but never opened, to go completely remote. Within eight long days, she produced a remote platform to provide five types of services, largely group-oriented (one-on-one sessions will wait until the in-person location opens). Mr. Katz — whose company had grown to seven locations in the Bay Area, with a new one set to open in Los Angeles next year — also made the decision in March to continue his business by going fully virtual.

Because both had planned, eventually, to offer remote services, they already knew that the efficacy of remote sessions was already proven. David Mohr, the director of the Center for Behavioral Intervention Technologies at Northwestern University’s Feinberg School of Medicine, who has studied the issue, said that researchers had long found that teletherapy could be as effective as in-person therapy.

“There are no substantial differences in outcomes between remote and face-to-face” therapy, he said, adding that a remote option can solve issues of distance and time constraints that often discourage people from seeking therapy. (Dr. Mohr, through his work at Northwestern, is the principal investigator for IntelliCare, a university program that provides pre-therapy tools for anxiety and depression.) Practitioners have been resistant to this change, but the pandemic has forced their hands.

“We are at an inflection point,” he said. “There is a greater acceptance of the use of technology in mental health care, while at the same time there is a tremendous decrease in the stigma” that had been associated with emotional problems.

Like Ms. Safira, it was personal experience that propelled Kyle Robertson to explore a platform for virtual therapy. The son of a psychiatrist and therapist, Mr. Robertson had difficulty finding help in dealing with his own depression and anxiety while a student at Wharton School of the University of Pennsylvania. He said his parents were hands-off but “definitely pushed early on for making sure that there was integration across medication and therapy,” which they all viewed as sometimes lacking in current practice, whether remote or in-person (only psychiatrists can prescribe medication).

After running a beta test of roughly 100 users at the end of 2019, he co-founded Cerebral in 2019. His timing, of course, proved prescient, and he has secured significant venture funding as well an uptick in clients throughout the year.

As with Two Chairs, Cerebral clients can schedule individual therapy, though group sessions are not yet available. The platform asks clients to keep track of their symptoms and report them monthly. Those responses can trigger a notification to the clinician to alert them if there is any worsening of conditions. If someone doesn’t respond, then someone on the team will reach out to check in, Mr. Robertson said.

All three companies seek to provide access quickly — the first interviews can be the same day after a client has signed up, in an effort to pre-empt mental health emergencies. The goal, Mr. Robertson said, is for new clients to speak to someone “within 10 minutes, something we’re able to do with a network of clinicians across geographies.” (Some of the regulations regarding licensing have been relaxed during the pandemic to enable telemedicine across all specialties, not just mental health care.)

And though these providers must comply with the stringent privacy laws that govern medical care, they are able to use data that they gather to analyze outcomes. “It’s been hard to aggregate data and use it in an effective way in the past,” Mr. Robertson said. “Many therapists are in the equivalent of mom-and-pop shops who don’t have the resources, or the time, to analyze the data.”

The three entrepreneurs are all working with insurance companies to have their services covered. Ms. Safira said that clients could use funds in their health savings or flexible spending accounts, and Mr. Robertson is negotiating with insurers. Mr. Katz said that while his company’s services have been out of network, “we will begin working with insurance companies more broadly in 2021.”

Their platforms welcome all ages. Mr. Robertson says that though some older clients seem less comfortable with the remote format, there are many who adapt.

Ultimately, all three companies hope to connect clients with the right type of therapy and to possibly contribute to the understanding of how to make a match.

“There’s not much research on how to make a match, but there’s a lot that speaks about the importance of the alliance” between therapist and patient, Mr. Katz said. “At the end of the day, if you form a great bond, the quality of care is so much higher.”

Covid 'Long-Haulers' Need Medical Attention, Experts Urge

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Covid Survivors With Long-Term Symptoms Need Urgent Attention, Experts Say

In a two-day meeting sponsored by the N.I.H., officials acknowledged an insufficient understanding of the issues and warned of a growing public health problem.

Chimére Smith, a teacher in Baltimore, has not been able to return to work since getting Covid in March. She said she has struggled for months to have her symptoms taken seriously by doctors.
Chimére Smith, a teacher in Baltimore, has not been able to return to work since getting Covid in March. She said she has struggled for months to have her symptoms taken seriously by doctors.Credit…Schaun Champion for The New York Times
Pam Belluck

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  • Dec. 4, 2020, 12:06 p.m. ET

There is an urgent need to address long-term symptoms of the coronavirus, leading public health officials said this week, warning that hundreds of thousands of Americans and millions of people worldwide might experience lingering problems that could impede their ability to work and function normally.

In a two-day meeting Thursday and Friday, the federal government’s first workshop dedicated to long-term Covid-19, public health officials, medical researchers and patients said the condition needed to be recognized as a syndrome, given a name and taken seriously by doctors.

“This is a phenomenon that is really quite real and quite extensive,” Dr. Anthony S. Fauci, the nation’s top infectious diseases expert, said at the conference on Thursday.

While the number of people affected is still unknown, he said, if long-term symptoms afflict even a small proportion of the millions of people infected with the coronavirus, it is “going to represent a significant public health issue.”

Such symptoms — ranging from breathing trouble to heart issues to cognitive and psychological problems — are already plaguing an untold number of people worldwide. Even for people who were never sick enough to be hospitalized, the aftermath can be long and grueling with a complex and lasting mix of symptoms.

The Centers for Disease Control and Prevention recently posted a list of some long-term symptoms, including fatigue, joint pain, chest pain, brain fog and depression, but doctors and researchers said they still know little about the extent or cause of many of the problems, which patients will develop them or how to address them.

Over the last several months, coronavirus patients with lingering, debilitating health issues have been widely referred to as “Covid long-haulers.” But some survivors and experts feel that name trivializes the experience, lessening its importance as a medical syndrome which doctors and insurers should recognize, diagnose and try to treat. One of the pressing issues patients and experts are now weighing is what official medical term should be adopted to describe the collection of post-Covid symptoms.

“We need to dig in and do the work that needs to be done to help relieve the suffering and stop this madness,” said Dr. Michael Haag, an infectious disease expert from the University of Alabama at Birmingham, who was a co-chair of a session.

In an inadvertent but stark illustration of the difficulty of the recovery process, two of the four patients scheduled to speak at the meeting were unable to because they had recently been rehospitalized. “Those individuals had their acute illness several months ago and they’ve been suffering pretty mightily since then,” Dr. Haag said. “And the fact that they’re still struggling with this gives extra power to what we’re trying to do today.”

Dr. John Brooks, the chief medical officer of the C.D.C.’s Covid response, the co-chairman with Dr. Haag of one session, said he expected long-term post-Covid symptoms would affect “on the order of tens of thousands in the United States and possibly hundreds of thousands.”

He added, “If you were to ask me what do we know about this post-acute phase, I really am hard pressed to tell you that we know much. This is what we’re really working on epidemiologically to understand what is it, how many people get it, how long does it last, what causes it, who does it affect, and then of course, what can we do to prevent it from happening.”

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Presentations from Covid-19 survivors — including Dr. Peter Piot, a world-renowned infectious disease expert who helped discover the Ebola virus — made it clear that for many people, recovering from the disease is not like flipping a switch.

Dr. Piot, who is the director of the London School of Hygiene and Tropical Medicine and a special adviser on Covid-19 research to the president of the European Commission, said he contracted the coronavirus in March and was hospitalized for a week in April. The acute phase of his illness involved some, but not all, of the classic disease symptoms. For example, his oxygen saturation was very low, but he did not develop shortness of breath or a cough until after he got home from the hospital.

For the next month, he experienced a rapid heart rate several hours a day, he said. For nearly four months, he experienced extreme fatigue and insomnia. “What I found most frustrating personally was that I couldn’t do anything,” said Dr. Piot, who now considers himself recovered except for needing more sleep than before his infection. “I just had to wait for improvement.”

Chimére Smith, 38, a teacher in Baltimore who has not been able to work since becoming sick in March, said she had struggled for months to have her symptoms, which included loss of vision in one eye, taken seriously by doctors.

“It’s been a harrowing task and the task and the journey continues,” she said.

Ms. Smith, who is Black, said it was especially important to inform people in underserved communities that long-term effects are “as real and possible as dying from the virus itself.”

The condition, she said, “not only needs to be explored, but it needs to be explained to the same group of people who suffer with being stricken with it the most, and that’s the minority population. I am not just here today for me; I am here for us.”

Hannah Davis, 32, a researcher and artist in Brooklyn, described neurological and cognitive symptoms that began in late March. “I forgot my partner’s name,” she said. “I forgot about sleep. I would regularly pick up a hot pan, burn myself, put it down, and literally do it again. I forgot how to shower. I forgot how to dress myself.”

Months later, some things have improved, but she still struggles to remember things, saying “I feel like I am basically on a 48-hour memory cycle.”

Ms. Davis is part of a long-term Covid survivor group called Body Politic and said a survey of 3,800 of its members in 56 countries has found that 85 percent report cognitive dysfunction, 81 percent had numbness and other neurological sensations, nearly half had speech and language issues and nearly three-quarters had some difficulty working at their jobs.

Clinics treating Covid survivors are seeing a striking number of people with brain fog and other thinking problems, as well as psychological issues, doctors participating in the workshop said.

“Approximately three months after their acute illness, more than half of our patients have at least a mild cognitive impairment,” said Dr. Ann Parker, who co-directs a post-Covid clinic at Johns Hopkins. “We’re also seeing substantial mental health impairments.”

Dr. Janet Diaz, head of clinical care for the World Health Organization’s Covid-19 response, said the agency is planning a meeting focused on long-term coronavirus effects and will soon start collecting data on post-Covid symptoms and medical visits.

She said that while doctors are accustomed to prolonged recovery challenges for people hospitalized for serious illnesses, the lingering symptoms in younger people and those who were not hospitalized for the coronavirus “urgently needs to be better understood and investigated.”

Building Emotional Safety Nets for Men

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Building Emotional Safety Nets for Men

Support networks with other men can help fend off the loneliness and isolation many men experience.

Credit…Leonardo Santamaria

By

  • Dec. 3, 2020, 5:00 a.m. ET

On the surface, Sean Kushigian and Jeff Compton didn’t have a lot in common before the pandemic. Mr. Kushigian, a 37-year-old banking analyst and self-described “extrovert,” surrounded himself with like-minded friends who didn’t discuss their problems and such “negative” feelings as fear and sadness, he told me, because they were a form of “weakness.” Mr. Compton, a 37-year-old chief technology officer for an online retailer and self-professed introvert, loved “being a good listener for friends’ problems,” he said.

Three months into the pandemic, these men — who live in different cities and have never met — both faced a common, defining struggle. Mr. Kushigian experienced a depth of sadness and depression he had never before known, his alcohol consumption spiked and he began having suicidal thoughts. Every time Mr. Compton went into a grocery store, “I found myself weeping,” he said, because the “panic and anxiety” he read on other shoppers’ faces mirrored back his own.

Mr. Kushigian and Mr. Compton are like many of the men I interviewed for my book on the need for greater emotional resiliency in boys and men.

As both men have discovered, the solution to their loneliness and emotional isolation is something few men have but many need: emotional support networks — with each other.

It’s no coincidence that men are at the fore of the public health crises filling our newsfeeds. Think: unemployment, opiate addiction and overdose, sexual violence, alcohol-related deaths and, of course, loneliness and spikes in suicide. This was before the pandemic hit. In a 2020 meta-analysis, Indian sociologists suggested that the “excessive pressure to conform to traditional modes of masculinity increases the risk of men’s suicidal behavior” amid the profound isolation of the pandemic.

We already know that men are far less likely than women to seek mental health help when they are struggling, even though studies prove that avoiding “negative emotions” leads to symptoms of mood disorders, including depression. What we may not know: Men, it turns out, suffer from anxiety and depression far more than we realize or like to believe. The diagnostic scales commonly used speak to symptoms that typically manifest in women (e.g., sadness, sullen behavior, loss of appetite). In men, however, depression is often masked beneath greater anger and irritability, risky behaviors, alcohol and substance abuse and leaning more heavily into such sanctioned escape valves as exercise regimens and work.

A 2013 study published in JAMA Psychiatry revealed that, when metrics were used that considered these differences across gender lines, “men and women met criteria for depression in equal proportions: 30.6 percent of men and 33.3 percent of women … When alternative and traditional symptoms are combined, sex disparities in the prevalence of depression are eliminated.” Perhaps not surprisingly, even when men do seek help, they are less likely to receive “adequate follow-up care” because health care professionals often misdiagnose their symptoms. These little-known breakthroughs change the conversation.

This jibes with the findings of a 2015 survey of 1,000 men conducted by Priory, a British mental health awareness organization, which found that 77 percent of men polled suffered from anxiety and depression. Forty percent of these respondents said that mental illness undermines their performance in jobs, parenting and relationships, but it would take thoughts of suicide or self-harm for them to consider seeking help.

All of this wouldn’t be such a problem if men were as effective as women at creating social support networks that double as therapy. (The gender disparity is evident in the numbers and types of support groups on Meetup.com.) A 2018 study among 15 New Zealand men ages 20 through 40 published in the American Journal of Men’s Health observed that, while some men do have diverse social networks, compared with women they “typically have smaller social networks and less frequent exchanges of social support with family and friends.”

Many boys and men I interviewed for my book assured me they didn’t need support networks, because they had a close friend or two in whom they confided. What these boys and men ultimately sought from male friends wasn’t emotional support; they used what I call “targeted transparency” for solutions to the few, carefully vetted problems they willingly shared. The truth is, many men can count on close friends when it comes to counsel and physical safety — but not their emotional safety.

The 2016 book “The Psychology of Friendship” which explores the wide-ranging role of friends in our lives, observes that boys are “trained” to follow a form of competition early on that defines their male-male friendships, discouraging honest emotional sharing “at all cost while encouraging direct competition and ‘one-upmanship.’” This ritualistic competition ultimately tends to create a profound deficit in many males, planting a deep seed of distrust in other boys and men. This is the reason Mr. Compton — as is true for most men — has more female confidantes with whom he shares his deeper emotional life. His male friends and family members “can’t be trusted,” he said, “to accept or engage with emotional honesty.” The last time he had male friends with whom he shared this kind of trust was during middle school.

The recent rise of men’s groups mirrors what researchers are discovering — that many men want safe spaces, or “containers” as groups call them, where they can practice emotional transparency and diminish their isolation, while relearning how to trust other men. The 2005 Irish study “Death Rather Than Disclosure” found that emotionally distressed young men “desperately wanted closer social connections and support from family members and friends,” but “they feared being judged as emotionally vulnerable, weak and un-masculine.” The lack of emotional networks has “negative implications for men’s social connectedness and mental well-being,” the researcher observed, putting younger men, especially, at “heightened risk of suicide.”

Mr. Compton eventually sought therapy and joined a men’s group online last spring. When the group began meeting in-person outside, his anxiety was so overwhelming he vomited before the meetings. Eventually, he shared with the group the deeper reasons for his severe reaction — the perceived threats of violence and rejection from other males whenever he revealed emotional honesty. To his surprise, one group mate texted Mr. Compton when he missed the next meeting, checking in on him and thanking him for his disclosure.

“That was powerful for me, to have another man accept my honest, deeper feelings,” he said. His isolation is gradually abating, as is his anxiety, and he’s starting to realize that his inability to “connect with other men emotionally was stunting my ability to find peace within myself.”

Mr. Kushigian also sought assistance — from a less conventional but increasingly popular outlet: online discussion forums geared toward mental health support. Online forums are “a good incremental first step toward reaching out for help,” John Naslund, an instructor in Global Health and Social Medicine at the Harvard School of Medicine, told me. “They’re great for guys to build confidence with sharing and asking questions” about their struggles.

Such platforms also offer anonymity. Early qualitative research shows that they can help men create connection and learn important coping strategies from people with similar struggles, promoting “self-seeking behavior, which is really important,” said Dr. Naslund, who studies digital mental health. He added that reputable organizations, such as the National Alliance for Mental Illness and Mental Health America, are good places to find such groups.

As for Mr. Kushigian, he spent the summer and autumn on the free platform tethr.men, which started last June and bills itself as the world’s first online peer-to-peer support group for men seeking emotional support. Matthew Zerker, the site’s founder, said it was developed in partnership with the Men’s Health Research Program at the University of British Columbia and the site HeadsUpGuys.org.

Mr. Kushigian said he now feels “much more comfortable” discussing his struggles. And he has noticed a sharp decrease in emotional isolation — in large part because of the power of commiserating with other men, something missing from his usual friendships.

“I feel like I’m never alone now,” he said.

Andrew Reiner is the author of “Better Boys, Better Men: The New Masculinity That Creates Greater Courage and Emotional Resiliency.”

Weekly Health Quiz: Better Masks, a Sleep Benefit and Another Coronavirus Vaccine

1 of 7

For better protection against coronavirus, experts recommend all of the following measures for masks except:

Having multiple layers of material

Using soft materials rather than stiff ones

Having ties rather than ear loops

Wearing a face shield rather than a mask

2 of 7

Over the past week, this state has had the highest number of Covid-19 deaths per 100,000 population:

Wisconsin

Texas

North Dakota

South Dakota

3 of 7

The drug maker AstraZeneca announced promising results from a new coronavirus vaccine that is made from a cold virus that affects these animals:

Dogs

Cats

Chimpanzees

Bats

4 of 7

All of the following sleep habits were tied to a decreased risk of heart failure except:

Getting seven to eight hours of sleep a night

Rarely or never snoring

Being a “night owl”

Feeling refreshed during the day

5 of 7

People who ate this style of diet were at the lowest risk of bone fractures:

Vegetarian

Vegan

Fish but no meat

Meat eaters

6 of 7

True or false? Teenagers can become addicted to the nicotine in e-cigarette products.

True

False

7 of 7

Girls born very prematurely, before 28 weeks of gestation, were at higher risk of this mental health disorder as young adults:

Bipolar disorder

Depression

Anorexia nervosa

Schizophrenia

The Narcissist Next Door

Paul Rogers

Does this sound like anyone you know?

*Highly competitive in virtually all aspects of his life, believing he (or she) possesses special qualities and abilities that others lack; portrays himself as a winner and all others as losers.

*Displays a grandiose sense of self, violating social norms, throwing tantrums, even breaking laws with minimal consequences; generally behaves as if entitled to do whatever he wants regardless of how it affects others.

*Shames or humiliates those who disagree with him, and goes on the attack when hurt or frustrated, often exploding with rage.

*Arrogant, vain and haughty and exaggerates his accomplishments; bullies others to get his own way.

*Lies or distorts the truth for personal gain, blames others or makes excuses for his mistakes, ignores or rewrites facts that challenge his self-image, and won’t listen to arguments based on truth.

These are common characteristics of extreme narcissists as described by Joseph Burgo, a clinical psychologist, in his book “The Narcissist You Know.” While we now live in a culture that some would call narcissistic, with millions of people constantly taking selfies, spewing out tweets and posting everything they do on YouTube and Facebook, the extreme narcissists Dr. Burgo describes are a breed unto themselves. They may be highly successful in their chosen fields but extremely difficult to live with and work with.

Of course, nearly all of us possess one or more narcissistic trait without crossing the line of a diagnosable disorder. And it is certainly not narcissistic to have a strong sense of self-confidence based on one’s abilities.

“Narcissism exists in many shades and degrees of severity along a continuum,” Dr. Burgo said, and for well-known people he cites as extreme narcissists, he resists making an ad hoc diagnosis of narcissistic personality disorder, as defined by the American Psychiatric Association.

The association’s diagnostic manual lists a number of characteristics that describe narcissistic personality disorder, among them an impaired ability to recognize or identify with the feelings and needs of others, grandiosity and feelings of entitlement, and excessive attempts to attract attention.

Dr. Giancarlo Dimaggio of the Center for Metacognitive Interpersonal Therapy in Rome, wrote in Psychiatric Times that “persons with narcissistic personality disorder are aggressive and boastful, overrate their performance, and blame others for their setbacks.”

According to the Mayo Clinic, people with a narcissistic personality disorder think so highly of themselves that they put themselves on a pedestal and value themselves more than they value others. They may come across as conceited or pretentious. They tend to monopolize conversations, belittle those they consider inferior, insist on having the best of everything and become angry or impatient if they don’t get special treatment.

Underlying their overt behavior, however, may be “secret feelings of insecurity, shame, vulnerability and humiliation,” Mayo experts wrote. To ward off these feelings when criticized, they “may react with rage or contempt and try to belittle the other person.”

Dr. Burgo, who sees clients by Skype from his home in Grand Lake, Colo., noted that many “grandiose narcissists are drawn to politics, professional sports, and the entertainment industry because success in these fields allows them ample opportunity to demonstrate their winner status and to elicit admiration from others, confirming their defensive self-image as a superior being.”

The causes of extreme narcissism are not precisely known. Theories include parenting styles that overemphasize a child’s special abilities and criticize his fears and failures, prompting a need to appear perfect and command constant attention.

Although narcissism has not been traced to one kind of family background, Dr. Burgo wrote that “a surprising number of extreme narcissists have experienced some kind of early trauma or loss,” like parental abandonment. The family lives of several famous narcissists he describes, Lance Armstrong among them, are earmarked by “multiple failed marriages, extreme poverty and an atmosphere of physical and emotional violence.”

As a diagnosable personality disorder, narcissism occurs more often in males than females, often developing in the teenage years or early adulthood and becoming more extreme with age. It occurs in an estimated 0.5 percent of the general population, and 6 percent of people who have encounters with the law who have mental or emotional disorders. One study from Italy found that narcissistic personality traits were present in as many as 17 percent of first-year medical students.

As bosses and romantic partners, narcissists can be insufferable, demanding perfection, highly critical and quick to rip apart the strongest of egos. Employee turnover in companies run by narcissists and divorce rates in people married to them are high.

“The best defense for employees who choose to stay is to protect the bosses’ egos and avoid challenging them,” Dr. Burgo said in an interview. His general advice to those running up against extreme narcissists is to “remain sane and reasonable” rather than engaging them in “battles they’ll always win.”

Despite their braggadocio, extreme narcissists are prone to depression, substance abuse and suicide when unable to fulfill their expectations and proclamations of being the best or the brightest.

The disorder can be treated, though therapy is neither quick nor easy. It can take an insurmountable life crisis for those with the disorder to seek treatment. “They have to hit rock bottom, having ruined all their important relationships with their destructive behavior,” Dr. Burgo said. “However, this doesn’t happen very often.”

No drug can reverse a personality disorder. Rather, talk therapy can, over a period of years, help people better understand what underlies their feelings and behavior, accept their true competence and potential, learn to relate more effectively with other people and, as a result, experience more rewarding relationships.

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How to Tiptoe Around a Depressed Mother

Giselle Potter

A depressed mother hates noise. She hates a lot of things — sometimes it seems as if she hates everything. But noise is her particular enemy. This is because she needs her sleep. She doesn’t always seem tired. But sleep is sacred to her, and you must never interfere with it. Particularly in the mornings. This makes life complicated if your bedroom — the nursery — is directly above hers and the floors are covered in linoleum, as they are in London in the 1960s. When you wake up and need to go to the bathroom you must avoid certain creaky spots. So you navigate like a cat burglar, tiptoeing on the more solid sections until you get to the stairs down to the bathroom. You hold your breath as you pee as if not breathing will somehow mitigate the sound. Do you flush? Not at this ungodly hour.

Silence is what your mother craves, but it is also her weapon. When she is in one of her moods, she settles into a powerful silence. She actively ignores you. She doesn’t respond to your attempts at conversation, your questions, your pathetic efforts to amuse her, to cheer her up. It’s as if you don’t exist, even when you’re in the same room. Over the years you learn what can trigger these silences and you do everything you can to avoid them. But when they inevitably settle in, it’s as if the world as you know it comes to an end.

Your mother’s depression, previously intermittent yet intense, has settled in with a permanence since your father left the house and your parents announced they would be getting divorced. You’ve always known she suffered from the blackest of moods. Your father has told you the story of your younger brother’s birth, and how he wanted the new baby christened Sebastian. But because your mother “wasn’t speaking” to your father throughout the period between birth and baptism, your brother is now called Paul.

Paul is the person you go to after you’ve been to the bathroom. He’s a little boy, just 4, and at three and a half years his senior it’s your responsibility to put him in his uniform, tie his tie and get him down to the kitchen where you make his breakfast. Your mother can’t tie a tie. And she doesn’t get up for breakfast. She doesn’t get up to see you off to school. The two of you eat quietly, grab your anoraks and having quietly shut the front door behind you, walk together. Recently, Paul has begun to stutter. Eventually he will be taken to a specialist who will try to find out the cause. Your father says he used to stutter a bit as a boy, too, and often imitates Paul. This drives you mad.

It’s hard to remember when you decided that you don’t love your mother. But there is a definite line in the sand when you become her fiercest critic. You hate her arbitrary moods. You hate her selfishness. You hate her neglect. Being depressed and being maternal don’t exactly go hand in hand. A depressed mother rarely puts her children first. For example, if on a Saturday morning you’ve been told to stay upstairs until your mother says you can come down, don’t (dying of boredom) find a rubber ball and start to play catch with it by yourself. Because every so often you’ll drop it. Eventually there will be a roar of rage from below. “GIVE ME THAT BALL,” she’ll yell. As you silently hand it to her, she will shout in your face, “GET DRESSED! AND GET DOWNSTAIRS!”

You’ll put on your clothes and creep down to the hallway with Paul. The two of you will half run, struggling to keep up with her as she marches rapidly and in silence out of the house and into Hyde Park about 10 minutes away. As you cross the street into the park she’ll hurl the ball into the trees.

“Go find your ball,” she will say. “And get lost.”

Having a depressed mother is an excellent way to turn a child into a liar. It’s completely against your nature, but some instinct in you makes you aware that there are some things your mother just can’t handle. So you lie by omission — you don’t tell her a lot of the fun things you do with your father. You’re hardly aware that you do this, until a few years later when Paul tells you he finds it easier to lie than to tell the truth. He’s more used to it.

Is it the lying that causes you anxiety? Or is it the general atmosphere in the house? Anxiety is the air you breathe, and it constantly affects how your body works. You’re supposed to put your light out at 7:30 at night, but sleep doesn’t come easily now, so you put your lamp under the covers and read for another two hours or so. Sometimes when you have to go to the bathroom you are too scared to, so you have accidents. You throw up from nerves. You watch yourself as if from a distance, interested in the experience, making a mental note of it.

You make mental notes of everything. (Having a depressed mother is great training for a journalist.) You note when the fridge is empty to get your mother to call the grocers. Your first experience of actual note-taking is when you decide to make shopping lists for her. You see when the laundry hamper is three-quarters full so you can start encouraging her to get the washing done. When she ignores you and you run out of clean underwear, you turn your dirty underwear inside out.

Routine is extremely important to children of depressed mothers. The clock becomes the nanny. Any deviation from a schedule is not to be allowed. The moment tea is over you take Paul upstairs for bathtime. You lay out your grubby clothes for tomorrow, and you brush your teeth. You go downstairs to say goodnight to your mother, now in her best mood of the day. There is a drink in her hand. She laughs as she allows the two of you to jump on her bed.

Then she says goodnight, and up you go to bed where you read about jolly red-cheeked children with fathers who smoke pipes and mothers who bake pies, wearing aprons over their tweed skirts, until you fall asleep.

Emma Gilbey Keller is a journalist and author who is working on a memoir about her experience of motherhood, from which this essay is adapted.

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Frequent Moves During Childhood May Be Bad for Health

Changing residences frequently in childhood may be bad for your health.

Using Danish government health data, researchers cataloged various adverse events — suicides or suicide attempts, violent criminality, mental illness, substance abuse, psychiatric diagnoses and premature death — in 1,475,030 Danes born from 1991 to 1997. Then they correlated these problems with the number of times each person had moved before age 15.

They followed the group through their early 40s and found that the likelihood of every one of those adverse outcomes tended to rise the more someone moved in childhood. Contrary to the researchers’ expectations, the associations persisted in both lower and higher socioeconomic groups.

The study, in the American Journal of Preventive Medicine, controlled for age, sex, parental age, degree of urbanization and history of mental illness in a parent or sibling. Although these factors had some influence, the separate effect of moving was still apparent: the more moves, the greater the number of psychosocial problems.

“We don’t want to create blame, where people start saying, ‘If only we hadn’t moved…’” said the lead author, Roger T. Webb, an associate professor in epidemiology at the University of Manchester in England. “We can’t say that there is a causal relationship” between moving and negative outcomes.

“The main thing is to understand how this group of young people can be so adversely affected across so many aspects of their lives,” he said.

War Wounds That Time Alone Can’t Heal

“Almost Sunrise”

A clip from “Almost Sunrise.”

By THOUGHTFUL ROBOT PRODUCTIONS on June 5, 2016.

No doubt in the course of your life, you did something, or failed to do something, that left you feeling guilty or ashamed. What if that something was in such violation of your moral compass that you felt unable to forgive yourself, undeserving of happiness, perhaps even unfit to live?

That is the fate of an untold number of servicemen and women who served in Iraq, Afghanistan, Vietnam and other wars. Many participated in, witnessed or were unable to help in the face of atrocities, from failing to aid an injured person to killing a child, by accident or in self-defense.

For some veterans, this leaves emotional wounds that time refuses to heal. It radically changes them and how they deal with the world. It has a name: moral injury. Unlike a better known casualty of war, post-traumatic stress disorder, or PTSD, moral injury is not yet a recognized psychiatric diagnosis, although the harm it inflicts is as bad if not worse.

The problem is highlighted in a new documentary called “Almost Sunrise,” which will be shown next weekend at the Human Rights Watch Film Festival in New York and on June 23 and 24 at AFI Docs in Washington, D.C. The film depicts the emotional agony and self-destructive aftermath of moral injury and follows two sufferers along a path that alleviates their psychic distress and offers hope for eventual recovery.

The new documentary “Almost Sunrise” follows Tom Voss and Anthony Anderson, two troubled Iraq war veterans, walking from Milwaukee to Los Angeles.

The new documentary “Almost Sunrise” follows Tom Voss and Anthony Anderson, two troubled Iraq war veterans, walking from Milwaukee to Los Angeles. Courtesy of Thoughtful Robot Productions

Therapists both within and outside the Department of Veterans Affairs increasingly recognize moral injury as the reason so many returning vets are self-destructive and are not helped, or only partly helped, by established treatments for PTSD.

Moral injury has some of the symptoms of PTSD, especially anger, depression, anxiety, nightmares, insomnia and self-medication with drugs or alcohol. And it may benefit from some of the same treatments. But moral injury has an added burden of guilt, grief, shame, regret, sorrow and alienation that requires a very different approach to reach the core of a sufferer’s psyche.

Unlike the soldiers who were drafted to serve in Vietnam, the members of the armed forces today chose to enlist. Those deployed to Iraq thought at first they were fighting to bring democracy to the country, then were told later it was to win hearts and minds. But to many of those in battle, the real effect was “to terrorize people,” as one veteran says in the film. Another said, “That’s not what we signed up for.”

That war can be morally compromising is not a new idea and has been true in every war. But the therapeutic community is only now becoming aware of the dimensions of moral injury and how it can be treated.

Father Thomas Keating, a founding member of Contemplative Outreach, says in the film, “Antidepressants don’t reach the depth of what these men are feeling,” that they did something terribly wrong and don’t know if they can be forgiven.

The first challenge, though, is to get emotionally damaged veterans to acknowledge their hidden agony and seek professional help instead of trying to suppress it, often by engaging in self-destructive behaviors.

“A lot of vets won’t seek help because what’s haunting them are not heroic acts, or they were betrayed, or they can’t live with themselves because they made a mistake,” said Brett Litz, a mental health specialist with the V.A. Boston Healthcare System and a leading expert on moral injury.

The second challenge is to win their trust, to reassure them that they will not be judged and are deserving of forgiveness.

Therapists who study and treat moral injury have found that no amount of medication can relieve the pain of trying to live with an unbearable moral burden. They say those suffering from moral injury contribute significantly to the horrific toll of suicide among returning vets — estimated as high as 18 to 22 a day in the United States, more than the number lost in combat.

The film features two very troubled veterans of the war in Iraq, Tom Voss and Anthony Anderson, who decide to walk from Milwaukee to Los Angeles — 2,700 miles taking 155 days — to help them heal from the combat experiences that haunt them and threaten to destroy their most valued relationships. Six years after returning from his second deployment in Iraq, Mr. Voss said of his mental state before taking the cross-country trek, “If anything, it’s worse now.”

Along the way, the two men raise awareness of the unrelenting pain of moral injury many vets face and encourage them to seek treatment. Mr. Voss and Mr. Anderson were helped by a number of counselors and treatments, including a Native American spiritual healer and a meditative technique called power breathing. They also found communing with nature to be restorative, enabling them to again recognize beauty in the world.

Shira Maguen, a research psychologist and clinician at the San Francisco V.A. Medical Center, who studies and treats vets suffering from moral injury, said, “We have a big focus on self-forgiveness. We have them write a letter to the person they killed or to a younger version of themselves. We focus on making amends, planning for their future and moving forward,” especially important since many think they have no future.

Dr. Maguen, who studied how killing during combat affects suicidal ideation in returning vets, found that “those who had killed were at much higher risk of suicide,” even when controlling for factors like PTSD, depression and alcohol and drug abuse. She said in an interview that decades after the Vietnam War “there was still an impact on veterans who killed enemy combatants, and an even stronger effect on those who killed women and children.”

Tom Voss’ journey took 155 days, spanning 2,700 miles.

Tom Voss’ journey took 155 days, spanning 2,700 miles. Courtesy of Thoughtful Robot Productions

To overcome veterans’ reluctance to seek help for moral injury, Dr. Maguen incorporates mental health care into routine clinical visits.

In Boston, Dr. Litz and colleagues are testing a related therapeutic approach called adaptive disclosure, a technique akin to confession. With eyes closed, the vets are asked to verbally share vivid details of their trauma with an imagined compassionate person who loves them, then imagine how that person would respond. The therapist guides the conversation along a path toward healing.

“Disclosing, sharing, confessing is fundamental to repair,” Dr. Litz said. “In doing so, the vets learn that what happened to them can be tolerated, they’re not rejected.” They are also encouraged to “engage in the world in a way that is repairing — for example, by helping children or writing letters.” The goal is to find forgiveness within themselves or from others.

One fact that all agree on: The process is a lengthy one. As Mr. Voss said, “I knew after the walk I still had a long road of healing ahead of me.” Now, however, he has some useful tools and he shares them freely.

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Overcoming the Shame of a Suicide Attempt

Jordin Isip

I don’t remember much about the first time I tried to kill myself, 21 years ago, because any time the memory popped up I deleted it from my mind like an unflattering photo on Facebook. Despite being open and public about my second attempt, in 2006, which I revealed in a memoir about my alcoholism, I’ve never told anyone else about that first one – not my partner of 25 years, my therapist of 10 years, family, nor friends – until now.

Here’s what I remember about that first time, in 1995. I felt hopeless, that my 27 years of life were done (27!). I’d come home drunk from a glamorous Manhattan book event, which I had organized as the publicist. The wattage of successful artists in literature, fashion and theater was blinding. I felt like a failure, that I would never be more than the hired help, that my own dreams were just thin air. When I came home and poured another drink and remembered the leftover painkillers in my medicine cabinet – prescribed for a sprained ankle earned by a drunken fall — I thought, “Why not?”

My attempt was impulsive, not premeditated. Had it been successful, I’d classify it as suicidal manslaughter. I climbed into the antique wrought iron bed I shared with my partner and passed out. The next morning, I woke up next to him and he was none the wiser. I got up in a daze and went to work feeling like I was moving under water, so heavy was my triple hangover from booze, pills and shame. I kept moving, kept drinking (I was blind then to the cause and effect of booze and depression) and kept silent.

My silence nearly killed me. Eleven years later, I tried again. I had been fantasizing about suicide every day for months. I was more hopeless. I was drunker. That time I did it with sleeping pills I’d been taking to prevent me from drinking as much at night. Booze, pills, suicide attempts: it was all one big happy “Valley of the Dolls” family. That time I took the pills in the morning after my partner left for work, and I didn’t wake up on my own. My partner found me in that antique bed when he came home from work. The jig was up, and my winding path to recovery began.

Why bother talking about the first one? Now that I’ve been sober for almost eight years and my artistic dreams are coming true, the secret made me feel like a house rebuilt on a foundation still riddled with termites. I knew I would have to own the attempt eventually, so when the Centers for Disease Control and Prevention recently released a report that suicides had surged to the highest levels in 30 years, I knew it was time for me to come clean. With two attempts on my score card, I forever remain in a suicide high risk group. According to the Harvard T.H. Chan School of Public Health, a history of suicide attempt is one of the strongest risk factors for suicide, and the American Foundation for Suicide Prevention reports that approximately 40 percent of those who have died by suicide have made a previous suicide attempt at some point in their lives. I don’t want the third time to be the charm.

The further away from that first attempt, the deeper the secret grew and the less real it became. I didn’t really do that. I didn’t think a few painkillers would kill me. I didn’t mean it. But I did do it and I did mean it. I’m mortified by that. It was reckless, rash, stupid, selfish, pathetic.

As a recovering alcoholic I know that admitting to my behavior and owning my story is the only way it can no longer own me. I’m not ashamed of being an alcoholic, but I’m still ashamed of trying to kill myself, even though I know I did it under the temporary insanity of alcohol. According to the A.F.S.P., approximately 30 percent of those who die by suicide have blood alcohol levels in the range of intoxication at the time of their deaths.

After my second attempt, I went to rehab and then to sober meetings. The focus quickly shifted from my suicide attempt to my alcoholism, and rightfully so. Once my alcoholism was treated, the depression lifted. It was alcohol that brought on my depression and thoughts of suicide, and ultimately twice gave me the courage to try it. Since I’ve been sober, I no longer suffer from depression, do not take antidepressants and no longer think about killing myself.

I’m fortunate to live in New York City, where there are almost as many sober meetings as there are bars. These are peer-led meetings of alcoholics helping other alcoholics, free of judgment and condescension. These meetings keep me sober, hence nonsuicidal.

But what about the nonalcoholics and nonaddicts who’ve attempted suicide? Where are their meetings? I could find only a few peer-led suicide attempt survivor support groups via Google, and none in New York City. When I called the National Suicide Hotline requesting local suicide attempt survivor support groups, the operator suggested just one option: a Safe Place Meeting hosted by the Samaritans, a suicide prevention network. But those meetings are for those who have lost loved ones to suicide, and they have no meetings for attempt survivors.

I admitted my second suicide attempt because I was found out, and had to. But shame kept me quiet about my first attempt. I admit it now, and I throw out a call for other closeted suicide attempt survivors to do the same: Own it, and find – or create — a safe group where you can talk about it.

Today I own my story, so that my story doesn’t kill me.

Jamie Brickhouse is the author of “Dangerous When Wet: A Memoir of Booze, Sex, and My Mother.”

The Breakup Marathon

Brian Eastwood during the Boston Marathon in 2016.

Brian Eastwood during the Boston Marathon in 2016. Zeth Weissman

Brian Eastwood was a pretty good runner, but he’d always come up a bit short in trying to reach his goal of qualifying for the Boston Marathon.

When he set out to train for the 2015 Vermont City Marathon, though, his 12th try at qualifying, he had something new in his life: a divorce.

“The day my wife and I went to court was the first day of 16 weeks of training,” said Mr. Eastwood, 35, of Somerville, Mass. His life was, to put it mildly, in flux. Not only was he on the verge of divorce, but he was in the middle of trying to make a career shift, too.

But his training paid off: Mr. Eastwood ran the race of his life in Vermont, finishing in 3 hours, 1 minute, 17 seconds, more than seven minutes under his best time, and more than eight minutes under the Boston Marathon qualifying standard for men his age.

His divorce, he says, most likely made the difference. During that difficult time, “running was my only real constant,” he said.

For some people, a life trauma like a breakup or divorce might mean curling up in bed and shutting down. But others find more active ways to cope.

Those people “are better at compartmentalizing or utilizing some of the energy that surrounds the emotions they’re experiencing — maybe it’s anger, maybe it’s sadness — and channeling that into another venue or arena,” said Trent Petrie, director of the University of North Texas Center for Sport Psychology. For runners, that could mean challenging themselves to run better and faster, or to shoot for a longer distance.

“Chronic or traumatic stress leads to structural and functional alterations in the traumatized brain,” said Ken Yeager, director of the stress, trauma and resilience program at the Ohio State University Wexner Medical Center. And while a breakup or divorce may feel like a single traumatic event, it is often the culmination of months or even years of “mini-traumas” and ongoing stress.

“You had those tensions building up in your body,” Dr. Yeager said. “Most people don’t realize the way you release those tensions is movement.” He compares the situation to the nervous tension that builds up at the start of a race. “Before any major race, you have this release of tension, and that movement is what releases the trauma and tension,” he said.

Maya Harmon, 32, ran seven half-marathons in 2015 — the year that she and her husband of seven years divorced. She’d picked up running in 2009 when she moved to Phoenix, but started doing it more when the marriage started to unravel in 2011.

“When things really started to go bad, I started to focus on trying to do something to stay active because I knew that as long as I stayed active, it would keep me slightly happy,” she said. Even though her time was limited between work, graduate school and becoming a single mother, she still got out there, trained and ran races.

Her mother asked if she was trying to run away from her problems. Maybe, she said, though the escape that running provided was at least a healthy one, and kept her from feeling overwhelmed.

“If I had time to sit and think about it, I probably wouldn’t have made it through that time,” Ms. Harmon said. “Running gave me something to focus on that was positive.”

Dr. Petrie says that while there’s a risk that running might be used as an escape that prevents people from confronting the issues that are causing their stress, it can also be a useful tool for processing painful events. “Sometimes in the moment, these escapes into running or exercising or finding a slightly different focus is a way for us to garner the psychological resources we need to circle back and face the other stuff in a more productive way,” he said.

For Ms. Harmon, who had been casually involved with the Black Girls RUN! group via Facebook before her divorce, running gave her a chance to expand her social horizons. She dove in to the local activities of that national group’s Phoenix chapter and is now their running ambassador, a journey that may have helped to strengthen her psychological resilience.

When people are “depressed or stressed out, they tend to isolate themselves, and that facilitates negative moods,” said Jasper Smits, a professor of psychology at the University of Texas at Austin and a co-author of “Exercise for Mood and Anxiety: Proven Strategies for Overcoming Depression and Enhancing Well-Being.” Studies he and his colleagues have conducted suggest that exercise may help to lessen anxiety and panic attacks and provide other benefits for mental health.

This past April, Mr. Eastwood ran that Boston Marathon for which he had worked so hard to qualify. Now his life is very different: He has a new girlfriend, a new job. He was recovering from a calf injury when he started training this time, so he set a more moderate goal. He finished in 3 hours, 24 minutes, 37 seconds, more than 20 minutes slower than his post-divorce performance, but he has no complaints.

“Everyone who saw me along the course said I looked happy and strong, which is exactly what I wanted,” he said.

Jen A. Miller is the author of “Running: A Love Story.”

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Treating Pregnant Women for Depression May Benefit Baby, Too

Treating pregnant women for depression may benefit not just themselves but their babies as well.

A study, in the May issue of Obstetrics & Gynecology, included 7,267 pregnant women, of whom 831 had symptoms of depression. After controlling for maternal age, race, income, body mass index and other health and behavioral characteristics, the researchers found that depressive symptoms were associated with a 27 percent increased relative risk of preterm birth (less than 37 weeks of gestation), an 82 percent increased risk of very preterm birth (less than 32 weeks of gestation), and a 28 percent increased risk of having a baby small for gestational age.

They also found that among those who were treated with antidepressants for depression — about a fifth of those with the diagnosis — there was no association with increased risk for any of these problems. But they acknowledge that this group was quite small, which limits the power to draw conclusions.

Still, the lead author, Dr. Kartik K. Venkatesh, a clinical fellow in obstetrics and gynecology at Harvard, said that it was important to screen mothers for depression, not only for their health but for that of their babies.

“By screening early in pregnancy, you could identify those at higher risk and counsel them about the importance of treatment,” he said. “Treating these women for depression may have real benefits.”

Living Near Greenery May Help You Live Longer

Hiroko Masuike/The New York Times

Living near greenery may help you live longer.

Researchers monitored 108,630 women who completed biannual questionnaires on their health and lifestyle from 2000 to 2008. During that time, 8,604 died. Using satellite imagery, they tracked the extent of seasonal vegetation where the women lived. The study controlled for socioeconomic status, age, race, body mass index, physical activity, smoking, education and other health and behavioral factors.

Compared with those living in the lowest one-fifth for greenness in the 250-square-meter area surrounding their homes, those living in the highest one-fifth had a mortality rate that was 12 percent lower. The study is in Environmental Health Perspectives.

Those living near greenery had a rate of deaths from respiratory illness that was 34 percent lower and a rate of dying from cancer that was 13 percent lower. But greenness did not affect mortality related to coronary heart disease, diabetes, stroke or infections.

The lead author, Peter James, a research associate at Harvard, said there were four factors in greener areas that helped account for the effects: less air pollution, more physical activity, more social engagement and, most significantly, better mental health, as measured by a lower prevalence of depression.

“This doesn’t mean you need to move to the country,” Mr. James said. “We found the associations within urban areas as well as rural areas. Any increased vegetation — more street trees, for example — seems to decrease mortality rates.”

Hormone Therapy for Prostate Cancer Tied to Depression

Hormone therapy for prostate cancer may increase the risk for depression, a new analysis has found.

Hormone therapy, or androgen deprivation therapy, a widely used prostate cancer treatment, aims to reduce levels of testosterone and other male hormones, which helps limit the spread of prostate cancer cells.

From 1992 to 2006, researchers studied 78,552 prostate cancer patients older than 65, of whom 33,382 had hormone therapy.

Compared with those treated with other therapies, men who received androgen deprivation therapy were 23 percent more likely to receive a diagnosis of depression, and they had a 29 percent increased risk of having inpatient psychiatric treatment.

Longer hormone treatment increased the risk: Researchers found a 12 percent increased relative risk with six or fewer months of treatment, a 26 percent increased risk with seven to 11 months, and a 37 percent increased risk with a year or more.

The study, in The Journal of Clinical Oncology, is observational, and does not prove causation.

Six Months Pregnant and Asking, ‘Am I Depressed?’

Stuart Bradford

On a walk with my husband through Joshua Tree National Park in late January, I felt sad for no reason in particular. Or maybe for lots of really good reasons. I wasn’t sure which it was.

At the time, I was six months pregnant. My husband, Raj, asked me what was wrong. “Nothing,” I said, and kept walking, kept stewing, kept wiping away a few tears from under my sunglasses when he wasn’t looking.

“Are you depressed?”

The Times had recently published a story about updated guidelines calling for pregnant women to be screened for depression – both during the pregnancy and after giving birth. Raj must have read the article, too.

During my first pregnancy, when I was quite happy, Raj read all about postpartum depression. Soon after our baby arrived, the questioning began. Raj would get all serious, look me straight in the eye and say: “Do you have postpartum depression?”

Umm. No, hon, I am feeling pretty good.

But this time around, this pregnancy, things have felt different.

Did I have “pregnancy depression?” Would I pass the screening? What’s the difference between being pregnant – with a crazy amount of hormones flowing through your body – and being pregnant and depressed?

It can be so hard to tell. Like when there is a blizzard back home but you escaped just in time, and you are sitting by the pool at a beautiful hotel in Palm Springs, and the air feels just right, and your toddler has finally gone down for a nap, and yet, you are crying.

Or when you wanted to go pumpkin picking so your husband tried to cheer you up by returning from Home Depot with a large pumpkin and orange mums. You know he was just trying to help, but pumpkin picking at Home Depot? Pregnancy depression might be when you can’t see the pumpkin and mums on the front steps without bursting into tears.

Is that pregnancy depression, or just pregnancy?

Pregnancy depression could be when your toddler is playing on the balcony outside your hotel room and for a split second you think: If he falls, he falls; it would be an accident. And it doesn’t immediately occur to you just how disturbing that thought is.

That’s shocking, but is it depression?

I see doctors and nurses every four weeks for my pregnancy. But they haven’t once asked me how I’m doing emotionally. One time I arrived for an appointment visibly distraught. I hoped someone would ask, but nothing.

I don’t know why I haven’t raised the issue myself. Maybe it feels like they aren’t the right people to discuss this with. The nurses take my blood pressure. I trust my doctor to perform a C-section, if need be. What do they know about moodiness?

On the other hand, in recent years there has been a real increase in awareness about mood disorders during pregnancy. If the medical professionals seeing pregnant women and new mothers aren’t looking for these things, asking the right questions and identifying patients who need help, then who is?

When we returned from Palm Springs, I looked deeper into pregnancy depression and what it means. The episode with our toddler on the hotel balcony had scared me. My thought was fleeting, but I was horrified that I could even think such a thing.

The more I read about pregnancy depression, also called perinatal mood and anxiety disorder, the more I realized it might not just go away. I began to worry that I would struggle even more once I gave birth and was home with our baby – sleepless and overwhelmed with a newborn and toddler, especially when my husband was out of town on business.

I also wondered if our toddler could sense my mood. And what if when the baby came, my sadness affected my ability to bond with him?

Moodiness on its own I can manage. But depression that could affect my children and my relationship with them? That was something I wasn’t willing to tolerate.

It was time, I decided, to talk to my husband.

When I called Raj, who was traveling, he could hear something off in my voice. This time he asked, “Are you sad?”

Yes, I was sad.

I told him I was concerned that my sadness over the past few months was a real problem. That it wasn’t going away. That it might get worse.

It helped being so honest with him, and with myself. He didn’t judge me, which now I realize was my fear. He told me it wasn’t my fault. He said he’d watch our son, and I could see a therapist or support group available on the weekends. He said he was glad I had told him – and I was, too.

The next day I contacted Postpartum Support International, an organization that supports women facing mental health issues related to childbearing, and talked to a coordinator in New York City. She gave me a handful of therapists to call.

Something changed after I acknowledged that I was struggling, that I needed help: I started to feel better.

I found a therapist who was warm and understanding and let me go on and on about my concerns about taking care of two children while my husband was away, and my fears that I wouldn’t be able to manage.

The therapist didn’t have specific answers. (And unfortunately she didn’t offer to lend a hand with late-night feedings.) If anything, she told me what I already knew – that it can be really hard to tell the difference between a wave of pregnancy hormones and clinical depression. She said it seemed that I was suffering from the former.

But we also agreed that what I was experiencing was real. That hormone fluctuations can manifest in many different ways, and that it’s often not enough to just ignore them. In fact, sometimes, it’s the very act of addressing them head-on that makes all the difference.

Hanna Ingber is an assistant editor on the International desk at The New York Times.

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Meditation Plus Running as a Treatment for Depression

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Meditating before running could change the brain in ways that are more beneficial for mental health than practicing either of those activities alone, according to an interesting study of a new treatment program for people with depression.

As many people know from experience, depression is characterized in part by an inability to stop dwelling on gloomy thoughts and unhappy memories from the past. Researchers suspect that this thinking pattern, known as rumination, may involve two areas of the brain in particular: the prefrontal cortex, a part of the brain that helps to control attention and focus, and the hippocampus, which is critical for learning and memory. In some studies, people with severe depression have been found to have a smaller hippocampus than people who are not depressed.

Interestingly, meditation and exercise affect those same portions of the brain, although in varying ways. In brain-scan studies, people who are long-term meditators, for instance, generally display different patterns of brain-cell communication in their prefrontal cortex during cognitive tests than people who don’t meditate. Those differences are believed to indicate that the meditators possess a more honed ability to focus and concentrate.

Meanwhile, according to animal studies, aerobic exercise substantially increases the production of new brain cells in the hippocampus.

Both meditation and exercise also have proven beneficial in the treatment of anxiety, depression and other mood disorders.

These various findings about exercise and meditation intrigued researchers at Rutgers University in New Brunswick, N.J., who began to wonder whether, since meditation and exercise on their own improve moods, combining the two might intensify the impacts of each.

So, for the new study, which was published last month in Translational Psychiatry, the scientists recruited 52 men and women, 22 of whom had been given diagnoses of depression. The researchers confirmed that diagnosis with their own tests and then asked all of the volunteers to complete a computerized test of their ability to focus while sensors measured electrical signals in their brains.

The researchers found that the depressed volunteers showed signaling patterns in their prefrontal cortex that are associated with poor concentration and focus.

Then the researchers had all of the volunteers begin a fairly rigorous, supervised program of sitting, followed by sweating.

To start, the volunteers were taught a form of meditation known as focused attention. Essentially entry-level mindfulness meditation, it requires people to sit quietly and think about their respiration by counting their breaths up to 10 and then backward. This practice is not easy, especially at first.

“If people found their thoughts wandering” during the meditation, and especially if they began to ruminate on unpleasant memories, they were told not to worry or judge themselves, “but just to start counting again from one,” said Brandon Alderman, a professor of exercise science at Rutgers who led the study.

The volunteers meditated in this way for 20 minutes, then stood and undertook 10 minutes of walking meditation, in which they paid close attention to each footfall.

Then they clambered onto treadmills or stationary bicycles at the lab and jogged or pedaled at a moderate pace for 30 minutes (with five minutes of warming up and five minutes of cooling down).

The volunteers completed these sessions twice a week for eight weeks. Then the researchers retested their moods and their ability to focus and concentrate.

There were significant changes. The 22 volunteers with depression now had a 40 percent reduction in symptoms of the condition. They reported, in particular, much less inclination to ruminate over bad memories.

Meanwhile, the members of the healthy control group also reported feeling happier than they had at the start of the study.

Objectively, the volunteers’ results on the computerized tests of their ability to focus and their brain activity also were different. The group with depression now showed brain cell activity in their prefrontal cortex that was almost identical to that of the people without depression. They could concentrate much better and hone their attention, attributes that are believed to help reduce stubborn rumination.

“I was quite surprised that we saw such a robust effect after only eight weeks,” Dr. Alderman said.

He and his colleagues theorize that the meditation and exercise may have produced synergistic effects on the brains of their volunteers.

“We know from animal studies that effortful learning, such as is involved in learning how to meditate, encourages new neurons to mature” in the hippocampus, he said.

So while the exercise most likely increased the number of new brain cells in each volunteer’s hippocampus, Dr. Alderman said, the meditation may have helped to keep more of those neurons alive and functioning than if people had not meditated.

Meditation also may have made the exercise more tolerable, he said, since some studies indicate that being mindful of your breathing and your body during workouts increases people’s enjoyment of the exertion.

“I’ve started meditating,” said Dr. Alderman, a long-time athlete.

Of course, this was a small study and the scientists did not follow their volunteers long term, so they do not know if any mood improvements linger. They also have no idea whether similar or even greater benefits might occur if someone were to run and then meditate or to practice both activities but on alternating days. They plan to study those questions in future experiments.

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Opening Up About Depression

Arianna Vairo

I have slogged through a number of difficult situations in recent months, among them the ongoing crises of my elderly parents’ illnesses and the suicide of a friend. I never lost my appetite nor burst into tears, and I didn’t suffer from any of the other typical symptoms of depression. Maybe I was more irritable than usual, a bit more prone to snap. And yes, I buried myself in my work. But I didn’t think I’d tripped down into the rabbit hole of depression.

You would think I would have been more self-aware, both personally and professionally. As a health journalist, I have often used my own stories to write about difficult-to-discuss medical conditions, includinglearning I had testicular cancer at age 26 and my misdiagnosis with H.I.V./AIDS — back when it was a death sentence. But I had never written about suffering from depression, even though it’s plagued me since I first put pen to paper, at age 11, when I started keeping a diary.

Still, I’m far from alone. At least six million men in the United States suffer from depression, according to the National Institute of Mental Health. The true number is likely to be even higher, said Dr. Matthew Rudorfer, the institute’s associate director for treatment research, since men are less likely than women to report classic symptoms like low mood, sadness or crying, so they often go undiagnosed. Men, he told me, more often demonstrate “externalizing” symptoms like irritability, anger and aggressiveness, substance and alcohol abuse, risk-taking behaviors and “workaholism.”

Oh, that macho thing: Men don’t get depressed; they just work, drink and compete harder. Andrew Solomon, author of the pathbreaking memoir about depression, “Noonday Demon,” told me that ridiculous attitude is part of the mind-set that guys should “cover up our moods with militarism or athleticism.”

So why speak up now? If there was a specific catalyst, it would be the death of my friend (his family asked me not to disclose his real name), a personal trainer who, one August morning, worked out his regular clients — and then went home and killed himself with a single gunshot to the head.

Even with 20/20 hindsight I never would have guessed he was at risk for serious depression, let alone suicide. Just three days before his death, alive with excitement, he’d talked with me about buying his first house and applying for a management role at the health club. Still, as one of his closer friends told me later, “You never know where depression lives.”

Most people, even those who know me well, don’t see my depression. I’m a “high-functioning” depressive, for sure, and perhaps an artful one, too, obscuring its symptoms with a mix of medication, talk therapy, exercise and knowing when to close the door on the world. And unlike my surgical scars (thank you, cancer), those left by depression are invisible.

I wonder, had I talked with my friend about my own struggle, if he might have said, “Me, too.” Indulging in some magical thinking, I imagine he would be alive today if we had shared our stories.

It’s encouraging that new studies are refuting previous ones that showed women to be twice as likely as men to experience depression. For example, a 2013 University of Michigan study concluded, “when alternative and traditional symptoms are combined, sex disparities in the prevalence of depression are eliminated.” In other words, men and women may be equally at risk.

The first step in recognizing depression in men is diagnosing it properly, which means establishing accurate criteria — and making sure mental health practitioners know what to look for. The second step, which may be even more difficult, is getting men to speak up about it.

Which leads back to my own silence. One reason I’ve been unable to talk about my condition until now is that, as the Cymbalta ad says, “depression hurts.” When I first heard that tagline I rolled my eyes, but I’ve since come to appreciate the copywriter’s genius. Imagine suffering from a bad flu, the kind that seems to have poisoned your blood, physically incapacitating you. For me, depression can feel like the worst flu ever, with no end in sight. It is tough to talk about when you’re in that much pain.

And then there’s the stigma. As much as I understand that illness is illness, whether mental or physical, and that there is a greater openness about depression now than a generation ago, I feel shame.

My own encounters with stigma have been profound. I once dated a fellow who dumped me unceremoniously when he found out I took Lexapro, an antidepressant. Before the Affordable Care Act became law, I was rejected for health insurance — not because of my cancer history, but because of my medication history. Having sought help, I was penalized. “It doesn’t make any sense,” my primary care doctor said to me.

So I have decided to be more truthful. Last fall, when I needed to beg off from a commitment, I didn’t fabricate some physical ailment, as I had in the past. Instead, I emailed: “The depression I’m suffering from right now makes it difficult for me to be there as promised. I’m sorry.”

Depression need not be the loneliest fight, as Mr. Solomon has so well characterized it. But if I don’t tell you, you can never really know me — or help. Now I can appreciate it when friends ask me how I’m feeling (but not in that dreadful way: “How. Are. You?”). And I appreciate those who offer: “Is there anything I can do?”

Steven Petrow, a regular contributor to Well, lives in Hillsborough, N.C.