Tagged Mental Health and Disorders

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.