Tape #250 - Taking Control - Preventing Depression and Anxiety

There's a significant problem in the United States and in South American, I believe that it's Venezuela that may have the highest rates of eating disorders in the world.  What is concerning is that in the United States 5 million women are effected.  We know eating disorders effect predominantly 90% of women, of course 10% are men.  We see men in the sports world, those who are weight-lifters, or are in sports where they have to be conscious of their weight.  What it is also tragic of 10% of women who are affected by eating disorders will die, will die.  When we're just starting to unravel what are the causes, what are the treatments, are their environmental factors, are their hormonal factors, how can we effectively treat it.  For example with Bulimia, we're now using the magic bullet pill that we've seen over the last few years prozac and we've seen some success rates, but we also know that we need to combine whatever medicinal therapies with psychotherapy.  When we talk about other problems we have to think about mental health issues such as anxiety and depression in a whole new perspective, and I think when you compare it to other medical illnesses it makes a wide impression on us.  For example, both cardiovascular diseases and mental illness vary from mild to life threatening we know.  In 1990, 18% of the US population had a cardiovascular disease but 22% had mental health disorders.  And I bet that number is even higher.  In 1990 the direct and indirect and related costs of treating mental health illnesses 148 billion dollars.  And that was only 12 billion dollars less than the 160 billion dollars in total cost to treating cardiovascular disease. So you see we have a significant health epidemic.  But we don't talk about mental health disorders as we do in the same framework as we talk about heart disease or breast cancer.  Fortunately, we have started to conduct research to understand how and why these disorders occur.  And we do have new therapies.  We know agents such as I mentioned prozac can be helpful, we know psychotherapy can be helpful, even shock therapies can be helpful.  We know for example, psychotherapies sort term 12 - 20 sessions have been very effective in treating less severe moderate forms of clinical depression.  There's cognitive behavioral therapies which have employed to treat young girls and women with eating disorders.  We also know that anti-depressants in combination with psychotherapy have been effective in treating about 85% patients with severe depression.  The question is does it prevent relapses and recurrences.  And that's what we're going to start to look into over the next few years.  Now are you familiar with panic disorders?  Have you ever known anyone that's ever had a panic disorder?  Do you feel comfortable sharing with us what you felt when you had a panic attack?  [Audience person speaking is inaudible]  When I worked in the emergency room, I went to a small hospital called Belview Hospital, it's a large hospital in New York City, and I thought I had seen everything and than I came to San Francisco General Hospital which was probably just as busy, but I had a little bit more time with my patients there, and I remember a young women coming in clutching her throat, saying she felt like she was having a heart attack.  And I thought, no, this isn't possible, there were no risk factors for a heart-attack, she was breathing very quickly, she felt like she was going to pass out, I took lab tests, her lab tests were off the wall because she was hyperventilating, and she really felt like the end of the world was about to happen.  That was my first introduction to someone having a panic attack.  And it can be terrifying, it's terrifying often for the provider when you don't know what your seeing, and it's certainly terrifying for the patient.  We don't have any known causes for it.  But fortunately we know, that we have some therapies to treat patients with panic attacks, some patients go onto agents called SSRI, serotonin-releasing uptake inhibitors, which is prozac, and psychotherapy helps, some patients may even know when they feel like something is coming on, but other patients are so overwhelmed by it, they try to avoid anything that they think than illicit it, and often these patients are afraid to out of their homes, to get into their cars, to cross bridges, and their lives are confined by their walls.  And until the psychotherapy their lives basically don't exist.  The quality of their lives don't occur.  It can consume them.  We know that 70-90% of patients with panic attacks or panic disorders can be effectively treated with anti-depressants or anti-anxiety agents and long-term therapy is around 35-50%.  I also want to talk about addictive disorders.  They say they often go hand in hand.  And we know that in the United States 5.5 million Americans abuse drugs, and it's 400,000 youths between the age of 12-17, and number that I find very concerning, over 100,000 pregnant women. And we know that when you are pregnant what you take into your system your fetus sees. Your infant can see.  We've seen children who are born to mothers who smoke who actually have higher rates of nicotine addiction later on in their lives.  Nicotine can pass through the umbilical cord.  That they are basically born addicted.  We all know about fetal alcohol syndrome.  And children who are born to mothers who have been on crack or cocaine and the problems we see there.  We know that there are a variety or behavioral interventions and we can talk about that later.  We know also that patients who have had problems with drug addiction as well as mental health problems have also experienced abuse in their lives.  And when I talk about abuse, I'm talking about physical abuse, I'm talking about rape, I'm talking a incest, but I'm talking about psychological abuse as well.  We know that 5 million women who have experienced an assault suffer from Post-traumatic stress disorder.  And that survivors of rape, or other forms of abuse are more likely than average women to suffer from emotional disturbances and including major depression, anxiety, alcohol and drug abuse, eating disorders, and even multiple personality disorders.  A majority of 75% of women who have institutional for mental illness have experienced physical or sexual abuse at sometime in their life.  And of that group 50-75% may abuse other drugs and alcohol.  So you can see we have a significant problem and when we talk about abuse I think we need to get into our minds that abuse can come in many forms.  It doesn't have to be just a slap, it doesn't have to be eyes are blackened or your teeth or knocked out, it can be put downs, it can be told that your not good enough.  When your working for example, in a male oriented role, such as agriculture, it could be that you can't compete effectively, your farm isn't in good shape, or your not doing something correctly, or perhaps if your a home maker that your not making the right meal.  All that builds up, and it takes away your self-esteem and your sense of control, and it can lead to depression, to anxiety, to even suicide.  And I think this is something that we can talk about here, what may be done from a community level to help women deal with this effectively.  Well the United States government has finally opened it's eyes and it's taken allot for that to happen.  It's taken first lady Betty Ford, whose suffered from alcohol abuse to come forward, Rosalyn Carter whose talked about mental health concerns, and Tipper Gore who we heard from today, Tipper Gore gave a speech for us about a year and a half ago, and she talked about her own mother who suffers from clinical depression, and what is was like to live with a mother who had her good days and her bad days.  And this fortunately has resulted in increased spending in research to figure how to better treat women and men and to develop better services so that women and men have places to go.  The National Institutes of Mental Health have many programs geared towards the diagnosis and treatment of mental health disorders and the gender differences, we have NIDA, the National Institute of Drug Abuse which is exploring how to effectively treat women with drug abuse problems.   We have different organizations which we work with from the public and from the private sector.  So we're finally starting to open the door.  Because we realize if we don't treat men and women effectively, especially women who are not usually treated correctly.  I think we all know the word hysterical.  Hysterical comes from the word hystriss which stands for uterus.  And the woman was told that she was crazy because she had a uterus, she couldn't help what was happening in her body.  Those ovaries just did crazy things to her.  So when someone might actually be suffering from a panic attack or an anxiety attack or from depression, it was all because she had a uterus.  And that was hence the term hysterical.  We're slowly moving away from that, but we do have a ways to go.  And I know that we in the United States for example, can learn from other countries.  So, I want over the next hour for us to make this interactive.  As I mentioned I am not a psychiatrist.  I deal with women from all age groups.  And my particular focus has been women past the age of menopause it began with this position, I deal with young girls and women. I go to college campuses all across the United States to talk about health concerns for young women.  And so, I think what we can do today is make this interactive and learn from each other.  These are just some of the basic facts, and I hope they will be helpful for you, because I'm sure in your own home countries you have similar numbers, perhaps a little higher, a little lower, but the numbers are still significant.  So what I'd like to do is open it up to the floor, and what we can do is do question and answer and make it interactive, I think we can learn allot from that.

 

I'm a physician, I'm a doctor, as I mentioned earlier, I had created the country's first women's health fellowship, and I had to do that working with all the different disciplines out there that have had a particular interest in women, and I'm also medical advisor for women's health, and I advise allot of people including our Surgeon General and Members of Congress and have worked with the United Nations Global Commission, I've been to Geneva, and I've talked with actually sixty leaders all over the world dealing with women's health concerns.  Issues that really have an effect throughout their life span, including mental health disorders.  So when I look at health, I look at it from a totality, I really believe that you can't treat someone's body without treating the mind.  And someone can not often have a healthy mind unless their feeling well.  So I think it goes hand in hand.

 

"Estrogen"

 

The question was the relationship of estrogen, and I'm going to tie it into mental health, question is should women be on estrogen, since the brain sees estrogen, and at what age, and what is the role of estrogen in the development of mental health problems.  Well I have my answers, but what I want to first do is see if any of you have answers or feelings and than we can go from there. 

 

Estrogen is a hormone that we all see.  Men and women included.  When we're fetus, when we're not even born yet, our bodies are flowing with estrogen because it receives estrogen from our mothers, estrogen receptors are found throughout the entire body.  We have estrogen receptors in our skin, we have receptors in our kidney, we have receptors in our brain and in our heart and in every organ system.  Which makes it quite interesting because our bodies are attuned to seeing estrogen, and as you go through menopause the estrogen levels very gradually decline.  It is a misnomer to think that once in menopause or post-menopausal that you have no estrogen in our body, you still do. How many of have fat.  How many of us have hips.  We all do. And some of us more than others.  And these women actually have more estrogen, because testosterone, a male hormone that is produced by the adrenal glands, can actually be converted into estrogen in our fat cells.  So, our estrogen levels never completely fall to nil, but they do get allot lower. Our brains sense that.  What happens when our brain sense it is several things, one we can have mood changes, sometimes we don't remember things like we used to, our memories can start to decline a little bit.  And we believe, we're starting to do research, for example, with the women's health initiative to access what is the role of estrogen in our long term memory and our psychological state.  Because again the brain has receptors for estrogen.  What we have seen is estrogen may actually improve of memory--what we call cognition, may improve our mood, and for some women may actually decrease the symptoms consistent with depression.  Now when we talk about depression, there are many different levels of depression, there is feeling a little bit blue, something bad has happened, and you just feel out of sorts, and that is normal.  We get concerned about this feeling out of sorts and blue when it exists for more than two weeks.  And it's accompanied with other changes, such as not wanting to eat, or maybe eating too much, or not being able to sleep, or not taking in enjoyment in our usual every day activities, and maybe not even remembering what we're supposed to do.  There were concerned about developing into clinical depression.  And we believe that clinical depression can have hormonal interactions as well as other environmental interactions, as well as neuro-transmitter causes.  Some women find that when they take estrogen whether they take it as a pill or a patch that they tend to feel better.  That the feelings of blueness, even anxiety tend to go away.  Everybody is different.  When I counsel a patient, I talk them not only about perhaps mental health concerns, but I look at other issues, such as ________, what are we concerned about when we go through menopause.  What's the number one killer for women in this country in most industrialized nations.  It's the leading killer for women in industrialized nations.  Another concern that we're worried about is osteoporosis, are you all familiar with osteoporosis, are dairy farmers definitely let us know about osteoporosis because fluid milk is one of major sources, of course, of calcium.  Osteoporosis is certainly a risk for all of us, men and women although women are 80% more likely to develop it.  And osteoporosis is a condition where the bones start to get thinner and are susceptible to fracture from just mild trauma.  And it can result hip fractures, as well as lower back fractures, as well as wrist fractures.  And we know that once  you have a hip fracture, you have a 20% chance of dying within the first year from that hip fracture.  So it has significant concern for us. So these are two areas I'm concerned about when I talk to a patient.  Another area is that I'm concerned about is breast cancer.  And there are a few studies that there might be a slight increased risk of breast cancer in women that have used estrogen therapy for greater than 10 years.  What we're starting to look at is that, is that a subgroup, do these women maybe have a genetic predisposition, are there other factors that may complicate it.  So, I look at it.  But I tend to put it on the line.  Because I'm concerned very much about heart diseases and osteoporosis and their quality of life.  Again, a few patients described hot flashes to me as power surges but overwhelmingly they don't come in as happy campers when they haven't slept for about five months because they feel like it's a hundred degrees at night, and when they walk down the street in the middle of Iowa and it's sixty below and they want to take their clothes off somethings wrong here there is a problem.  So we talk about quality of life.  There are some issues now where we can perhaps use lower doses of estrogen therapy for shorter periods of time, we can alternate.  And we see that there tends to be a benefit.  One thing that is important is that as you go into menopause it's important to think about it years before.  And this is where we're educating providers to talk to patients.  So you know what questions to ask to start thinking what you can do to protect your health.  So I hope I answered that a little bit.  It's an individual decision, you've gotta way to pros the cons, but again, if the quality of your life is affected, your feeling that you have hot flashes, your feeling depressed, your memory is impaired, it may be worthwhile to try estrogen therapy, even for a short period of time to get you over that hump.  Most women seem to do better within about a year, a year or two after there menopause has developed.  Women may not need if they don't have other risk factors for heart disease and breast cancer.

 

Another issue which I want to talk about is exercise.  How many of you exercise?  How many of you would like to exercise?  Exercise has been one of our greatest agents out there.  It's a mood elevating drug.  And I use the word drug very lightly.  It increases serotonin and opiate levels, our own bodies endorfans, our own morphine basically.  We find exercise as very helpful to decrease our risk for developing often depression, as well as to fight off anxiety, as well as to keep our bones healthy and our hearts healthy.  When we talk about exercise, we talk about it as far as 30 minutes everyday most days of the week.  And it doesn't have to be all at once.  I'm not asking all of you to go out to the treadmill after this.  But I am asking you to take the stairs when you walk down to your next meeting, and I am asking you to walk around the block if you can, I'm asking you, even in your hotel room, to do some sit-ups, or push against the wall, or just do jumping jacks, just move your bodies.  And again, ten minutes here, ten minutes there, ten minutes later it all adds up to about 30 minutes a day.  And we have found decreased rates of depression, as well as anxiety, as well as helping our hearts, as well as our general feeling of well being.  Now the session was termed I believe was taking control.  Taking control.  You know that women who feel that they don't have control in their lives.   Whether their, stressed, how many of you have ever felt stressed?  I love this, when people come up and they say, I don't know why I'm tired.  And you ask them, well what do you do during your day?  Well, I'm up at 5 o'clock, and I'm getting... let's say if your on a farm, and your doing what have to do, and I've never lived on a farm, and I can only imagine, your up at 4 o'clock probably, and then you take care of your kids, get them ready for school, whatever you have to do, and if you have a husband that's just like another kid, you feed him and cloth him and make sure that he's all taken care of and happy, and than you take of what you need to do within your home, and than let's say you work out of your house, now you gotta drive like 30 miles to get to where you need to be, than you gotta deal with all your phones calls, now we have a wonderful age of communication, I know when I come into my office, I run in, I see someone within my office, and you can vouch for that, I run in I get the lights on, turn on the computer, check my voice mail, than check my mail, than start checking my email, and I do it all at once.  And by fifteen minutes I'm exhausted and I need to go home.  There's just too much there to contend with.  I've only been gone from my office for 10 hours.  And there's so much to do.  And people from Israel now can email through the night.  Which is marvelous.   We're doing a conference with Israelis.  So I have a stack of things to do.  And all of us have that.  We have so much we contend with in our day during work.  And than we decide it's time now to leave so we can go home and relax.  And you get in your car and you have everyone cutting you off and it's rush hour.  And if you live in a place that there's snow you get stuck and your sitting there for two hours but than your phone can ring and your beeper can go off.  It's wonderful.  And so by the time that you get home you can now make dinner.  And after you make dinner, you can than talk to your children, teach them, and maybe you can talk to your husband and you talk about what you've done.  And than you realize that you have to do laundry you forgot about that.  So you go and you do your laundry.  And now it's 11:30 and you realize you haven't paid your bills yet, and their going to probably turn out the lights, and you don't care.  And you to sleep, if you can having nightmares about the thirty things that you forgot to do. So than we ask why are we stressful and anxious, and do we feel depressed?  I don't know the answer to that.  My answer is that we need to hire more husbands to be wives.  You have to admit that's true.  So we deal with the world all around us, and I've talked to women who are in villages in Thailand.  I've tracked into these villages, and there's an interesting village in Thailand, where the women go out to the fields, and I'm not sure what they men do, I'm not sure at all, but the women are the ones who go and they do the agriculture, and they do the farming, and then they come in and they take care of the village.  And their stressed.  It's really amazing.  It think it's a universal issue where ever we go around the globe, we try to do too much. And I've been told by researchers who do brain research, and this is true, that women are able to multi-task more affectively, our brains are wired, our corpus claus in that central part in our brain so that we can do many things, and men are tend to uni-task and maybe that's what keeps their rates of depression and anxiety a little lower.  We see everything

maybe because we had to, in our hunter and gathering days, we had to be aware of everything around us, our children, our vegetables, and our farms, and the men just went out, and said OK I've gotta kill the tiger, that's it.  Kill the tiger.  We have assimilated that into our lifestyle and this is what we have to contend with.  And I want to talk about how we can take control of our lives so that we can this done, but we don't feel the anxiety and depression.

 

How do we prioritize our lives?  How do we do it when we live 28-hour days when it's only supposed to be 24-hours?  Time management and we talk about it and what I'd like to do is break that down to what is time management.   Because we can talk about taking control and we can talk about psychotherapy, and pharmakinetics and we can do that, if your interested we can do that.  But I think you hit something even more important.  How do we in our lives do this?  How did you make time in your lives to do this?  Prioritize.  You delegate it.  Who did delegate it?  So if we can do this, where we have decided that this conference is important enough, than why can't we do that in other parts of our lives?  What is the reason for us not doing it.  We choose not to.  Is it part of our X chromosome?  That we must do unto others as we wouldn't do to ourselves.  I really think that there are important messages here.  It's the basic values.  The point here for those in the back who are listening to the other conversation in the next room, is that we live in a world that we can turn on a TV set, or we turn on the Internet and we have access to everything and it makes us want.  We see what someone else has and we may want it and it looks wonderful and we want it, so we think if we work harder we'll get it and everything will be better and we'll be happier.  And than in the long run we find out that we're too tired and we're too stressed out to enjoy it.  How many of you have ever taken a vacation and your just so exhausted that the first week your just so exhausted that you just can't do anything.  And than the second week your nervous about coming back to what you have to do because your going to be punished for being gone for two weeks.  All of us are like that.  So we've almost created our own health, so to speak.  I think when we talk about mental health we know that for example as I mentioned there are physiological reasons behind it.  And I think we all understand that.  But I think that we're talking about something really almost equally important, and that is how does our life effect our mental health.  And I think we can get some really interesting solutions here.  I think that's a very important point.  We live in world where we actually isolate ourselves.  How many of you live in farms where your about a hundred miles from somebody or some other group or fifty miles?  How many of you live in suburbs?  Do you know your neighbors?  Your friends with them?  How many live in towns where you don't really know the people around you?  I think that what we have realized for ourselves, perhaps we're the survivors here, is that we need to know people.  But we live in a very isolated environment.  We go home at night we do turn on that TV set or we turn on our computers.  But we don't have those coffee clatches, or those sewing clubs, or whatever it used to be those communities networks that are very important.  We seem isolated.  What we have done even in our workplace, we go into work, if you don't work in your home, if you work outside, we don't communicate.  We talk to people all day but we don't communicate.  What we started doing in one office, is that we have like a self-help group once a month,  and we meet.  And each of us are able to communicate.  And what it does is it allows us to alleviate our own anxiety and depression.  We can cry, we can laugh, we feel secure about what we say in this group stays among us.  And we share our experiences, and it is so therapeutic that we're able to go out and combat the world that we have to do it.  But we are able now communicate.  It's not that we have to be one-on-one with a psychiatrist or psychologist.  Sometimes our best caregivers are those who are around us who are in similar situations who also have clear minds about what's happening or lived through it.  How many of you have ever lost a spouse?  Certain rooms I go in, are divorce?  Whatever it may be, loss.  The most helpful thing we've found is to communicate to talk to other people to share our grief and our experiences.  And that often is the best medicine.  We see when we talk and we share our endorphin levels go up.  All the wonderful positive hormones that our body needs go up.  So it's very important.  It also allows us to take control of our lives.  That we are in command of what our emotions are, that it's OK to feel sad, and upset. And we can share these emotions. 

 

[These are comments made by the speaker in response to audience statements]

If they are going out and saving all these communities, have they looked at what's happening within their own little environment.  Are they more happier or are they more stressed out because now their saving everyone.  Have they looked at that?

 

It's very important to have support.  Reaching out to ask for help.  Whether it's that you need psychological counseling or other types of counseling, or medical therapy.  We now need a change in our mind set that it's a sign of weakness, but it's actually a sign of strength.

 

I think the underlined message is that you took control of your lives and in your lives you have many factors, and there are environmental factors, and their are community factors, and so you went to the people who may have the power to influence them.  And by doing that you've taken back control in your lives.  And that's a point, you don't want to just sit there and be negative, negative, but you want to have positive outcome.  But I think it is helpful at times to verbalize.  And to get it out on the table, but try hopefully find that peaceful solution.  That good solution.

 

The problems here and I'm sure in the stresses that your experiencing it's the family, making sure the units _____, but also running the farm, and making sure it survives.  And that's enough for forty people to handle.  And our minds and our bodies are generally not equipped to handle what forty people can.  So the coping mechanisms have to change.  You mentioned that men, they don't like to communicate.  In many studies show that men do things differently and they don't communicate they way the women traditionally do.  Some folks think, is that why they earlier.  In ten years, will women's death rate be the same as men?  We hope to have everyone live longer, but perhaps with more open communication.  One of the issues is if men and women can evolve into the way where they can communicate.  Because you can't control what's happening in these change of  governments.  But you can control what's happening on your farm, and the relationships with those who are your people on your farm, which are your husband and your children.  And that's where I think the communication and what you were saying bridging the world around you to make it a supportive role.

 

Will they come back and talk to you though afterwards.

 

It's interesting to see the different experiences.

 

Again keep in mind that two things are happening here.  One your applying, and I don't mean to stereotype men and women, it seems this way.  He has that one goal.  At that moment your going to be talking about what am I going to do in the future.  So your working that, but your also taking charge and control of your life, and deciding how your going to go over the next five or five months or whatever.  And that's very helpful.  I think one thing we're learned, if you can set goals for yourself.  Even if there goals, what are you going to do for the next hour.  Perhaps sometimes it's helpful even make a list, over the next 24-hours this is what I want to accomplish.  Now be realistic, you don't want to write that you'll be writing the great America-Australia novel.  But maybe you'll read five pages of a novel. Might be good.  But you make out a list so that at the end of the day, you can cross off things and you've accomplished something.  And we have seen that, it's a sense of accomplishment.  And we have seen that does for some women remove some of that anxiety that your not doing enough.  You are prioritizing, you setting realistic goals, and you can see that you've done it.  And it can be helpful. And than in communication with your partner, your husband, you can set or you have one meeting a week even where you can talk about it, it's helpful.

 

Your question is focusing on an issue that is a bit different from what we have been talking about.  And I'm glad that you brought it up.  There are those who suffer from depression, or other mental health disorders, such as schizophrenia, bipolar disorders, that may not even be environmental related, or situationally related that require the intervention of the health care system to its fullest extend, whether it be perhaps hospitalization, or medications or psychotherapy or shock therapy.  As we've talked about.  And there the difficulty is getting that person to come into care.  And your dealing with two issues here.  One that the illness itself, you do not recognize that you are ill, or two you do recognize it and your afraid to go.  Or perhaps a third one their is no situation there to reach.  We've been talking in another session for example about migrant farm workers.  And that there is some systems in the United States where we don't have health care policy for these workers.  In some communities we're starting to change that,so even If someone is ill, we can get them the help that they need.  If  you have a loved one and perhaps yourself, and you are recognizing mental illness, you can call the local public health service, perhaps in the Australia, you have a similar service, there are private sector mental health organizations, for example that may provide you the access that you need.  And than, of course, it's getting your individual, or your loved one, or yourself into that health care  you need.  And that is the most difficult step, but it may take one or three times, or five times to access it.  There are people who talking isn't going to help they do need medical intervention, and you can talk until your blue in the face, if somebody has for example, if somebody has diabetes, I can say to you, your sugar level is going to get better, you just don't eat that candy, it's all going to be fine.  That has nothing to do with what the problem is, they made need insulin.  And we make sure that individual gets the care.  And if you have somebody denies that they have a problem, one of the first things that you can do if get yourself help.  There are for example Alcoholics Anonymous, there are other groups, perhaps you can get into your own group, perhaps you need psychotherapy.  When you first deal with what your reactions are, so that you help your self, because unless you help yourself, and than often you get in a situation where your enabling and it's a whole, you down a path that their problem with alcohol becomes your problem.  And visa versa, if you have a problem with alcoholism, you have got to take control before you can help anybody else.

 

It's really good you brought up the signs of mental illness. We are going for example, to high schools and colleges to young girls about depression and eating disorders, and substance abuse, and other issues where young people hurt themselves and they don't know why they do that.  But unfortunately with mental illness you don't have a blood test that you can run or I can show you an xray.  If your just not feeling right, it last longer than just a few weeks, your enjoyment of your life is altered, you need to reach out and get help.  Because it's there and mental illness can be curable.  Now your friend, your neighbor who you eluded to she's now dealing with the guilt of she didn't do enough on that.  And so there's this whole generation down the road of lives that have been affected by this.  It's tragic.  Often, what happens is that we have seen rates of suicide,

often happen after an individual some amazing feet that they have this goal, their accomplishing it, and why their doing it, their mind might be on something else, and than afterwards there can be that let down period, and again whether it's neurotransmitters or what not, than they commit the act, often as people start to physically better sometimes they commit suicide, prior to that they just don't feel well enough to do it, ironically enough.  When you mentioned hereditary--it's very important.  Alcoholism is an inherited disorder, bipolar disorder, manic depression can be inherited disorder, as well as major depression.  And that is something that we're starting to understand.  And it's important when you go to your health care providers if they ask you these questions, that means than you need to know the answers.  Have there been family members who have been involved in alcoholism or substance abuse?  Have there been suicides in the family or individuals who've been depressed?  Or have been hospitalized for psychiatric disorders?  That is equally as important to know--because it is inherited doesn't necessarily mean will you get it .  But you might have a higher predilection.  When we talk about women and alcoholism, it's a real interesting scene that we're starting to understand now, we know that women can get ellibriated one drink--for example, versus like two for men, we also know they can suffer more liver damage.  Some of the metabolism for alcohol can be different, and we also know that stopping alcohol and cigarettes may be more difficult for women.  Women I know many of my patients, in the afternoon they have their little ice tea or lemonade, it's spiked with vodka, and it's clear, so nobody knows it.  And now I think our greatest tragedy is to get help for people who don't know they need it and their families are not in tune, or they don't want to see it.  I hope that kinda answered one element of the question.  Cause we're really are dealing with two issues.  There is the situational issue which I think many of you have marvelous suggestions.  And than there's their other issue where you do need to get psychotherapies, medicinal therapies, and possible hospitalization.  I have a story, one of my interns was manic depressive, her father was alcohol and manic depression, and my intern inherited that, inherited the manic depression and she used to call me when she would cut herself, you know, she had a problem, she couldn't stop that, and she would call me from the emergency room from Georgetown emergency room.  And I always knew when she would start to cycle down, because her energy levels would change it little bit, than she would do this, and than she would get the care and than she' do OK.  For me it was really something to see it first hand, you know you read about it, and you treat a patient, but until you have someone that your taking care of, it's very difficult, I used to be angry at myself, why couldn't I see that, I'd just spent a whole week working on a project. But there are times you can't and this is where medical care needs to come in very quickly.  How many of you are familiar with St. John's Wart for depression.  I think you've seen it advertised on TV.  I have two views on that, it potentially could work, but I haven't seen any studies.  St. John's Wart is an herb that is found to have properties that may be similar to say prozac. It's the natural prozac. That patients have said they feel better when they take it.  And I don't know there's truly a placebo  effect.  So what I'd like to see, their starting to happen, the NIH for example, are starting to launch studies looking into this agent, to see if really does have an effect.  We know that there is a placebo effect out there, that if you take control than you tend to feel better.

 

I think it's interesting though and I've talked to people who've tried it.

 

It's the question of children and being exposed to it, either they see it on TV, or they just turn on the news, or their in an environment  where mom is hit by dad, or mom hits dad or whatever it may be.  Little ones reflect it, it comes within there system, we've seen higher rates of head injury, and we know we're coming into trouble when we see higher rates of pets being injured, because we've seen children actually hurt pets as means of immolation or that's what they've learned is OK.  Because they've been hit themselves.  So it's an interesting society, everyone says that we've become a more violent society.  Yet, when I go back and look through history books, I think we've always been a violent society.  From our neandrothal days.  Just now we're more in tuned to it.  And that we're being bombarded with it.  I know many of you listen perhaps to farm reports. So perhaps you have the TV on.  It might be helpful at night just to turn everything off.  Because if you can't control it and it's not going to affect you the next day, why do you need to know about it.  It just allow your body and your mind to decompress.  And that's where you take those little holidays and those breaks.  And that may be very helpful.  A little holiday maybe just for the night, but that's where it's just blocking out the world around you.

 

It must be very, very difficult, how do you have times for yourselves? You don't.  Alright now lets talk about that for a moment.  You took the time to do this now.  Why couldn't that happen for something else.

 

And yet, what made you decide to walk away from it. And you did it. Good for you.  Because you do have to break away and it is prioritizing. 

 

Could it be possible that on all of your farms, that there could be a system developed where you could have that one week? 

 

Let's say god forbid that you were diagnosed with breast cancer and you had to go to the hospital and you had to have surgery, what would happen, the farm would go on.  Or you had a heart attack, the farm would go on would it not?  So why do we have to wait until that element happens to that stat.  But see at this point, by doing this here, what it shows me that your committed to yourselves and that is very important to take that extra step.  Because it's not ingrained into our head.  My great grandma had eighteen children, and they were farmers, apparently there as a cow Betsy who fed all of the kids.  So I owe my good bones to Betsy. And now their ranchers in Colorado.  And it was interesting, because my mom was trying to explain what my great grandma went through, but my mother's life in many ways was more complicated and she only had four kids.  So, your doing everything now, twice as much that generations before you have done.  So just like a machine has to have the parts repaired, you have to do the same for yourselves. 

 

You just don't do it. And it's difficult, it's changing patterns.  Our behaviors.  Again, we can't judge ourselves by anybody else, or what our mothers did, or by what our fathers did.  It's what we are in this world right now.  We do need money to do things that's correct.  And you need money to manage your farm.  But it takes money also if  you get ill.  It's re-prioritizing that.   So perhaps you start out with that one hour a week maybe. That it is your time, it's your time you have to take it.

 

And that's again making that list.  You'll see me walking around the office, with these yellow stickies on my jacket, and I have lists, because I just can't remember where I put them. So I wear them on my lapel, they become my pin.   And I have to do this, this, and this.  And when you get organized you do so much more and you can have that one more hour, and it doesn't cost anything.  And now I can either listen to music for an hour, or read a book, or whatever it might be, but you gotta take that control back into your lives.

 

That's simple.  It doesn't take very much money to do this.  I have about 5 more minutes, because I have to go back to my office to give a talk to college students.  Which is a joy for me to do, but I have to do the commute thing.  So I have about 5 more minutes and I want to take a few more questions, or comments, or suggestions.

 

There actually more productive, is that possible in the communities where that can be done.  Can you come into coalitions with a few other women within your community, so that perhaps  you help them one time, and than they help you, and it frees you to do something that maybe you need to do, and something good, not necessarily take the kids to school or to the doctors.  But something for yourself, and sharing.

 

So that you created new needs to fit your new situation again.  Because this age is very different from what it was fifty years or seventy five years ago, and all solutions don't work, and if you keep going at this current pace in ten years your going to be burnt out.  And your children how will they see a reflection to want to be farmers.  And how will you even want to continue in it.  And so what your doing is your protecting your dividends now, and in the future, start looking at your life a little differently. And it's not to take away from what your doing, it's to compliment it, and to add everything that you can in your life, but at certain times.

 

I want to thank you, in fact we gave you applause for coming. I think you all deserve applause for coming.  It's truly amazing.  And I think you have some down time so you can all go take walks.