Dealing With the Winter Blues

http://www.thedailynewcanaan.com/wellness/dance-or-sing-or-read-winter-doldrums-away

Dance (or Sing or Read) Winter Doldrums Away

by Jeff Deitz MD02/17/11

Jeff Deitz MD has some advice for besieged, snow-laden New Englanders.

Tired of being cooped up? Tired of feeling frigid and isolated? Afraid to drive for fear of black ice or sustaining a compound fracture getting into or out of your car? Fellow Fairfield County denizens, take heart. You are not alone!

More than half the new patients who’ve consulted me since Christmas about depression connect the winter weather with their emotional wellbeing. Disruptions at work, school and home are causing stress, especially the small business owners and employees who depend on customer traffic. You’d think the snowplow drivers and plumbers would be happy about their booming business, but being besieged with irate calls from homeowners who can’t get out of their driveways or use the water because of busted pipes is not a lot of fun.

Given that we’re only half way through winter, with more of the same predicted, here’s what I’m telling my patients about staying sane.

Rule number one. Stay physically and mentally active. And, as Stew Leonard says, “Rule number two: when in doubt, refer to rule number one.” The most adaptive coping I know is to make the best out of a bad situation. Use this time to reassess your lifestyle and introduce healthier habits. Make a list — it’s a great way to prioritize your goals.

If you have stairs, walk up and down them. If you have on old Jane Fonda CD, dust it off and get moving. Dig out your Led Zeppelin or Santana and dance — it’s enjoyable for the family and good for your relationships. The last deejay party my wife and I attended felt like an hour of aerobics! Remember, you don’t need a gym membership to do pushups or stretching, and coffee table books make excellent free weights.

Use your imagination. Listening to music is good but making music is even better. Get out your guitar. Play a few scales on that trombone or clarinet. Plug in the bass (assuming the electricity is still on). The next thing you know, you and your spouse or kids might be jamming or working on a new tune. The same thing applies with books, as reading a good story is stimulating. Making up a new one is even better. Try this: gather the family and have someone make up the beginning of a story. Every two minutes get the next person to continue. And so on. It’s fun.

What do kids do on snow days? They play and improvise. Why shouldn’t we?

You get the point. Get off the couch and turn off the tube. It’s a perfect time to bust out the Wi Fit or open the Rosetta Stone you got for Christmas. And here’s the best news of all, anything new you learn, you get to keep forever. Besides, since you’re not going out to the mall, it won’t cost you a dime.

Editor’s note: Jeff Deitz MD is a psychiatrist and psychoanalyst in Trumbull and New York. He lives in Norwalk and teaches at Beth Israel Medical Center. He writes about mental health topics for the New York Times.

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Schools Start too Early for Good Health The Daily New Canaan August 27, 2010

http://www.thedailynewcanaan.com/opinion/schools-start-too-soon-good-health

Schools Start Too Soon for Good Health

by Dr. Jeff Deitz 8/27/10

Across Fairfield County, parents are bracing for a nightmare: dragging teenagers out of bed and getting them to school by 7:30 a.m.

First-period teachers look at their students’ yawning, dreamy faces, “Why bother starting school so early? They’re still asleep.”

As a medical doctor, I am convinced that sleeping is exactly what adolescents should be doing at 7:30 a.m. At that time, the final bursts of REM sleep – so essential for learning and well-being – are in progress. This I know for sure: Too little sleep makes teenagers irritable, depressed and illness-prone. Phenomenologically, sleep deprivation looks exactly like Attention Deficit Disorder. Even worse, sleepy teenagers are involved in more automobile fatalities.

“Adolescents need eight to nine hours of sleep per night,” Brown University sleep researcher Dr. Mary Carskadon told me recently. “Their biological time clocks run later than their preteen siblings. They’re hard-wired to go to bed and wake up later. Sleep deprivation rivals childhood obesity and cigarette smoking in terms of its public health menace.”

Mornings are different in Wilton. The district changed its middle and high school start times to 8:20 a.m. in 2003, after a yearlong campaign by the Wilton League of Women Voters. The group produced a report worthy of publication in a medical journal.

Recently, league spokeswomen Carole Young-Kleinfeld and Lisa Bogan described the initiative to me. “It was a classic example of a grassroots change. Everyone got involved,” they said proudly, referring to the communitywide cooperation that overcame many obstacles, including bus schedules for elementary students and early dismissals for after-school sports.

The result: “Middle-schoolers get off the buses smiling and joking in the morning. Despite the athletics departments’ concerns, Wilton High’s teams are winning more state championships than ever,” said Young-Kleinfeld.

Wilton High’s Associate Principal Robert O’Donnell said the change has been good for students. “Based on our experience here in Wilton and the compelling research on circadian rhythms and adolescent sleep patterns, we believe that it is the right decision for our students, which is what matters most.”

We’re the most affluent, best-educated county in this country. If one town can overcome the obstacles and get school start times right, so can that the rest of Fairfield County. Wilton showed us that it can be done and how to do it.

It’s time to wake up and do what’s right for our kids.

Jeff Deitz MD is a psychiatrist and psychoanalyst in Connecticut and New York City. He teaches at The Beth Israel Medical Center. He’s been a New Canaan resident for 25 years.

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The Saddest Exacta I Ever Cashed New York Times November 8, 2010

http://therail.blogs.nytimes.com/2010/11/08/the-saddest-exacta-i-ever-cashed/?scp=1&sq=deitz%20rail%20blog&st=cse

November 8, 2010, 11:57 am

By JEFF DEITZ

Classic finish line.John Sommers II/Reuters Mike Smith and Zenyatta nearly caught Blame at the finish line. The exacta paid $33.20.

Jeff Deitz M.D. practices in New York and Connecticut. Two decades before he psychoanalyzed his first patient, his father taught him to read the form at Pimlico.

Ten days ago, on my Friday train home from New York City to Connecticut, I sat across from an older gentleman whose youthful eyes were buried in newsprint: the early edition of the Breeders’ Cup past performances. In this era of the Kindle and IPad, the sight of 60 dog-eared, pencil-marked pages made me smile and took me back to when I discovered that most mysterious and perplexing mélange of letters, numbers, symbols and fonts: the Daily Racing Form.

The man had a gentle demeanor and a mystical smile, which reminded me of my father and the many magical Saturdays I spent with him at Pimlico in the era before Lasix, speed figures and exotics trying to discern which $3000 claimer had the greatest likelihood of staggering to the finish line first without either hemorrhaging to death in plain view or being vanned off for a more civilized demise.

My commuting buddy and I quickly agreed that what made this Breeders’ Cup so special was the Classic and Zenyatta: Will she, or won’t she? Every horseman in the land wanted a chance to beat her. I’d been thinking about the race ever since the connections decided to return the reigning champion for another shot at glory.

From before 125th Street until I got off in South Norwalk, we fleshed out so many angles on the subject: what the pundits were saying: the switch from synthetic to dirt, coming from behind in a loaded field, the fate of great racemares in the breeding shed. Somewhere around Stamford, he asked me who I liked to win the race. I had already thought about the outcome many times, but putting it in words was very unpleasant: I didn’t like what I thought; and I didn’t like what I felt.

For many people, a casual look at the form is like looking at a music score. What you see is what you get. Studying the score, however, is a whole different matter: that’s where a musician sees more than the notes; it’s where he feels the music; and, there are many ways to interpret each piece.

Handicapping-wise, my father was a confirmed sentimentalist, which was how I learned to read the form; and lead my life. He didn’t bother a lot with details like pace and trips. When New York allowance horses shipped in to face Maryland circuit-based sprinters in the weekly $25,000 sprint stakes with names like the Anne Arundel County Purse, or the Hutzler Handicap, he usually went for the local horse on the comeback trail, or a horse stepping up in class; he rarely picked logical favorites, and neither did I. He claimed he bet Sagamore Farm’s Saggy, the sire of Carry Back, the day Saggy beat Citation in a Derby prep race.

As happens during psychological maturation, and thankfully for my wallet, I eventually learned to read the Racing Form much more cerebrally, more like applied psychoanalysis, the idea being that unraveling the past is the key to understanding the present.

When you get right down to it, handicapping horse races is about applying the knowledge of what has happened in the service of predicting what will happen; no surprises here: it’s precisely how our minds work. Every second of every day, we take in huge amounts of data via our senses, most of which is processed unconsciously and assimilated into memory; Why? Because we need innate mechanisms that compare the present and the past. It’s how we make sense of things, calculate the odds of good outcomes as opposed to bad ones, and proceed in a complex world where the best we can do is calculate probabilities that guide future actions.

So how do people learn and make decisions? Via two simultaneously-operating parallel systems: the Cerebral and the Emotional. There’s no way around it, is what there is to work with: coolly-thought-out logic and gut feelings. Unlike the machine on which I’m writing, which registers the letters regardless of how tenderly or roughly I type them, the human processor has feelings about what it processes. So there it is: The feeling brain that makes inferences and thinking brain that draws conclusion are hard-wired into the same hard-drive.

If I had my way, I’d teach a course on how reading and interpreting the Racing Form prepares people for life by showing them how the cerebral and the emotional can inform each other,
“I want Zenyatta to win with all my heart,” I told my fellow traveler. There was absolutely nothing cerebral about how I felt. “Her victory in last year’s Classic gave me more chills and tears than Secretariat, Seattle Slew and Affirmed-Alydar combined. I want that feeling again,” I said.

The man’s smile reminded me of the look on my father’s face when he told me his story about Saggy.

“But,” I added, picturing the way the race would be run, “my head tells me, ‘no.’ There’s just too much to overcome. The form tells you. She has to go all out to beat an undistinguished group of fillies. She’ll be too far behind to get there in time.”

As I left the train we wished each other luck.

I spent Friday and Saturday in a trance watching the races. Between Unrivaled Belle, Goldlikova, a hefty payout for place on Central City, and sticking to my guns about not betting on 2-year-olds or races in which I had no clear conviction, I was comfortably ahead turning for home.

Getting 4-5 on Zenyatta, a horse that would be coming from dead last against a field like this struck me as beyond absurd. I looked over the form again, and when I saw Blame at 5-1 I thought the world had gone mad. What were people thinking? And then it hit me: they weren’t thinking at all. They were betting with their hearts. Millions of dollars worth.

If using one’s head to modulate one’s heart is a metaphor for success in life, I did well to bet the race as I did. My head said I did a good piece of analysis and my heart is pleased that I didn’t throw my winnings away on a whim. But although it was huge payday, I felt crushed all the way to the bank.

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Talk Therapy can be Potent Medicine; New York Times April 13, 2011

http://well.blogs.nytimes.com/2010/07/01/talk-therapy-can-be-potent-medicine/?scp=1&sq=deitz%20psychotherapy&st=cse

July 1, 2010, 12:07 pm

By JEFF DEITZ, M.D.

I’d just finished a family session one Thursday morning when my emergency line rang. A faint voice croaked: “Dr. Deitz. Please. Can you help me?”

Jeff Deitz, M.D.Jeff Deitz, M.D.

A woman I’d been treating for more than 14 years was calling, but I barely recognized her voice. She and I had been through many difficult periods over that time: her agitated depression as a 28-year-old newlywed, which led to the diagnosis of bipolar disorder; a disabling postpartum depression two years later when her daughter was born; her daughter’s leukemia at age 5, when my patient spent her nights maniacally scouring the Internet for experimental treatments.

This time was different. I’d never heard her sound so disconsolate. I asked her what was wrong, trying to recall our last session. (The details of our conversation have been changed to protect my patient’s privacy.)

“I can’t get out of bed,” she said. “Remember how my sister and I are rowing the Head of the Schuylkill this weekend? If I back out now, she’ll never speak to me again.” Rigorous exercise and a powerful attachment to her siblings, the core of her social network, were her major coping strategies. “Can I see you today? Maybe you can adjust my medicine,” she said.

We arranged an appointment for that afternoon. She managed to make it to my office, her face taut and pasty, her sweat suit drooping about her lanky body like a shroud.

“I don’t know what happened,” she replied when I asked what made her so depressed. “I felt fine when I left here two weeks ago. And now this,” she said, sounding defeated. “I got depressed for no reason.”

“For no reason?” I echoed, rephrasing her statement into a question. I remembered previous times when her moods fluctuated viciously in reaction to stresses of which she was unaware.

“Nothing I can think of,” she answered in a monotone.

“Are you sure? Really sure?” I pressed, urgently.

“There is one thing,” she said. She then started into her recollection of a conversation she’d had the previous weekend with a pushy woman she barely knew.

“This is what she said,” she continued, mimicking the woman’s finger-shaking and fire-and-brimstone tone: “I can tell from your description of your daughter, you’ll see what a handful she will be. Just wait until she hits puberty. My daughter didn’t want anything to do with me for years. She still treats me like a stranger.” The more my patient talked about that encounter, the more energized she became, perking up in front of me like a wilted plant that’s been watered.

“So, something did happen,” I said, underscoring that her mood change didn’t happen in a vacuum. I asked her what that woman’s statement meant to her.

She began to weep, then sob, as if her daughter had died. “I can’t bear the thought of losing her,” she said. “We’re so close. The idea she won’t want anything to do with me is overwhelming.”

I asked her if the woman had a degree in child development.

“I doubt it.” Her forehead relaxed.

“The woman didn’t evaluate your daughter psychologically, did she?” I added dryly.

“No. She wasn’t a therapist.”

“She couldn’t be,” I said semi-indignantly. “Besides, what kind of person dumps such a load of garbage on someone she hardly knows? Imagine being that woman’s child. I wouldn’t talk with her either.”

She smiled.

“As for your daughter,” I said, “let’s not jump to conclusions. I’ve seen you two many times in the waiting room. Not that adolescence is a Sunday stroll, but I think the two of you will do just fine.”

“You really think so?” she asked.

“Absolutely.”

“I never looked at it that way,” she said, grinning, the tension in her neck and shoulders melting away.

“Good,” I said. “Let me know how your regatta went.”

My patient called the following Monday. “It was great,” she said. “Until we talked, I had no idea how much that woman upset me.”

Looking back, I did nothing extraordinary. I delivered competent therapy; effective therapy. I presented my patient with a different perspective, punctuated with humor, empathy and conviction — something my colleagues do every day.

I helped her become aware of her powerful but unconscious reaction to the pushy woman, reframing their interaction while playfully confronting her tendency to idealize authority figures. I also affirmed she need not be a victim of her perceptions and mood. By viewing her situation in a different light, I led her do the same, resulting in a rapid mood improvement.

And unlike medications for depression, which take weeks to become effective while symptoms abate gradually, her immediate reaction to psychotherapy speaks to a different mechanism of action and confirms what neuroscientists are demonstrating: social interactions, including psychotherapy, turn on brain circuits instantaneously. Why? Because humans are social animals; we’re wired to connect.

Neurons in the premotor cortex and the somatosensory cortex — mirror neurons, as they’re known — fire in synchrony with the behavior and feelings of others, attuning people’s brains. When a person sees someone smiling, some of the observer’s smile-controlling neurons are turned on, too. Or when someone winces in pain, the corresponding sensory neurons in the observer fire away in sympathy.

The premotor cortex, command central with respect to voluntary behaviors, is where decisions to act are made. Evolutionarily, it’s a tremendous advantage to learn coping through observation and imitation — mirror neurons’ raison d’être — whether learning to harness fire to deal with the elements, or learning to self-regulate, self-soothe or self-reflect, or any of the other myriad coping skills that modulate mood.

Think of how it feels for the depressed person, whose pervading negativism colors his or her thoughts, feelings and behavior, to be with an optimistic, yet not Pollyannaish, person who radiates confidence, warmth and humor while affirming that situations can be interpreted differently; how refreshing and hope-engendering it is to be with someone who not only understands one’s misery but says something that makes a difference.

I’m not implying that a single encounter in the therapist’s office can cure depression. But a major psychotherapy goal for all patients is to turn on coping routines on their own.

Even experiences with strangers can powerfully influence mood when the chemistry, and the neurophysiology, is right. People who start therapy, for example, frequently talk of hitting it off with their therapist and of leaving the initial sessions feeling hopeful. Research confirms that liking one’s therapist early on and feeling that the therapist tunes in well to one’s issues bodes even better for therapy than the therapist’s experience or training.

The effective therapist offers more than sympathy; by empathizing with his patient’s suffering, he confronts distortions and maladaptive behavior and mirrors healthy coping. Good therapy is lively, sometimes playful, but always interactive and full of genuine humanity. Ineffective therapy may neither help nor harm, but improperly conducted therapy, ranging from overly passive to dictatorial and cruel — no matter how it’s couched and rationalized — leaves patients dejected or, worse, hurt and turned off.

One small disclaimer: although good therapy has no side effects, it may become habit-forming.

Jeff Deitz, M.D., is a psychiatrist and psychoanalyst in Connecticut and New York City. He teaches at the Beth Israel Medical Center.

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Athletes Struggle to Channel Aggressive Nature New York Times November 21,2009

Box Seats

Athletes Struggle to Channel Aggressive Nature

By JEFF DEITZ
Published: November 21, 2009

P

Left, Andrew Schwartz/Reuters; Kathy Willens/Associated Press

Serena Williams, left, had a tantrum that contributed to her loss in this year’s U.S. Open women’s singles final. Jorge Posada, center at right, fueled a brawl when he elbowed an opponent.

A college soccer player retaliates against an opponent by pulling her down by the ponytail. A tennis champion has a tantrum on the court, costing her a shot at winning another major title. An all-star catcher throws an elbow, touching off a brawl that puts his teammates at risk for injury.

Peter Schols/Reuters

The French star Zinédine Zidane, above, was ejected for head-butting Italy’s Marco Materazzi in the 2006 World Cup final in Germany.

Aggression is a basic component of human instinct. Without it, no athlete can succeed. But if it runs amok or is misguided, it can undermine the most-talented competitor. When athletes lose it — that is, lose control of their aggressive impulses — fans are right to wonder, what was he thinking? Or even, was she thinking at all?

Thinking, debated for centuries by philosophers and psychologists, has more recently been the subject of extensive neuroscientific investigation that explores it at the level of brain cells and brain circuits. Humans, we now know, are born with an instinctual brain surrounded by a thinking brain.

The instinctual brain, which evolved first, consists of interwoven nodes of nerve cells, called neurons, whose job is to preserve the organism’s integrity and survival. Instinctual behavior includes hunting and eating, affiliating for play and reproduction, and detecting and responding to threat. The instinctual brain, which makes rapid, if crude, all-or-nothing assessments about danger, is the seat of intuition and of gut feelings like dread and aggression. It is wired to initiate complex, reflexive movements, many of them aggression-laden, like diving for a fumble or smashing a crosscourt backhand, actions that would be impossible to perform effectively if one had to think about them.

But a highly functioning instinctual brain is not enough to ensure success at the highest levels of sports, and if it leads to reckless behavior, it can cause an athlete to fail, or to self-destruct.

This is where the thinking brain comes into play. The thinking brain, the cerebral cortex, consists of the outermost layers of neurons, which interact with one another and with the instinctual brain’s neurons.

In humans, the thinking brain developed in complexity along with the evolution of language, judgment, voluntary movement, planning and impulse control. These capacities enabled man to protect his vulnerable body from predators, to adapt to his environment and to become the dominant species. The thinking brain is where rules reside — rules for society, and rules for games.

During play, thinking and instinct coexist in delicate balance. While the instinctual brain drives motivation and the passion to win, the thinking brain must rein in aggression and funnel it toward the proper target. Think of the raw power of Serena Williams’s forehand, or the brute force of a linebacker in tackling a ball carrier.

At Madison Square Garden, as at Gettysburg, the instinctual brain activates us via a robust, hard-wired network of nerve pathways that prepares us for combat. Picture a one-way interstate: 10 lanes of traffic crammed with urges to pummel a boxer who is on the ropes, to hurl a 96-mile-per-hour fastball at a batter’s head, or to scream at a linesman who has made a questionable call.

If athletes heeded only the law of the jungle, chaos would reign, for when aggression runs rampant, impulse control fails. The mental toughness needed to control aggression boils down to the thinking brain’s using strategic planning, judgment, concentration and impulse control in the service of winning. Mentally tough competitors stay on task, inhibiting or redirecting aggressive urges.

Consider, for example, the presence of mind demonstrated by a ballplayer who, when victimized by a bad call, coolly initiates a conference among the umpires even though the natural instinct is to bite their heads off. But unlike the fast-flowing 10-lane highway, the thinking brain’s inhibitory connections to the instinctual brain are narrow, windy and need more maintenance. And yet no athlete becomes a champion without fortifying these pathways.

So where do champions find it, this road to keeping aggression under control? Books can help, but reading about managing anger without practicing it is like trying to hit Mariano Rivera’s cutter after studying a manual on batting mechanics.

Champions must learn to control aggression under game conditions. Visualizing what lies ahead is crucial because being caught off guard by unexpectedly tenacious opponents drives the instinctual brain into fear mode, increasing unhelpful aggression. Sports psychologists offer many tried-and-true techniques, including attention-focusing exercises, progressive muscle relaxation, guided imagery, meditation, deep breathing and yoga.

Biofeedback studies confirm that physiological arousal is lowered by mental exercise. Finding it, as opposed to losing it, means taking the thinking brain’s strength and agility out of the mental workout room and onto the playing field. Tiger Woods calls this being in the hunt, where coping techniques rehearsed and mastered keep maladaptive aggression from distracting the athlete from the primary goal: winning.

The spectator sees the contest on the field, but the champion battles more than the opponent; he wrestles with the animal impulses within. That is why the great ones thrive in the heat of competition. For them, it is one more opportunity to work on finding it.

Jeff Deitz is a psychiatrist and psychoanalyst in Connecticut and New York.

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