Wednesday, September 27, 2017

Getting Older Can Mean You Have More Choices

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Too often, experts say, myths about aging get in the way of older people staying connected or pursuing what is meaningful to them. CreditNathan Benn/Corbis, via Getty Images
The realization that you are getting older can come in waves.
You watch movies and point to the actors, saying: “She’s dead. Oh, he’s dead, too.”
Your parents move to a retirement community they call God’s waiting room.
You hear more snap, crackle and pop in your joints than in your breakfast cereal.
In society, youthfulness is glorified and getting older is cast as something to avoid, but as your age increases, your quality of life does not necessarily have to decrease, experts said.
Here’s what you should know:

What is ‘old’?

Most people wouldn’t say that a 38-year-old qualifies, but once you pass the median age of 37.8, you may statistically be considered “old,” said Tom Ludwig, emeritus professor of psychology at Hope College in Holland, Mich.
Studies show that people start feeling old in their 60s, and a Pew Research Center survey found that nearly 3,000 respondents said 68 was the average age at which old age begins.
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Daniel B. Kaplan, an assistant professor of social work at Adelphi University in Garden City, N.Y., said in an email that living to an advanced age was a relatively recent achievement.
“The average human life span gained more years during the 20th century than in all prior millennia combined,” he wrote, adding that the average life expectancy in the United States is 79.1.

Gain perspective

Dr. Gayatri Devi, a neurologist at Lenox Hill Hospital in Manhattan, said that your outlook can make a difference.
She recalled a patient who frequently said, “Old age has an ugly face.” The patient died when she was 84.
Another patient, who was 98, told Dr. Devi that when she was younger she looked like the actress Elizabeth Taylor. When the doctor told her that it must be difficult for someone who was once that beautiful to have aged, the patient remonstrated: “What do you mean? Am I not still beautiful?”
That patient is now 100.

Diversify your friends

Dr. Devi said a patient who died at 101 had told her to try to have a friend “from every decade of life.” He had befriended an array of people, including Dr. Devi’s daughter, who was 12 at the time.
Having friends from multiple generations can help head off the loneliness that can come when others move, die, get sick or are no longer mobile.
“It speaks to an antisegregation of the aged, maintenance of community, as well as keeping in touch with modern advances to prevent being accused of being an old fogey,” she said.

Get ready

Many of the problems that adults face as they get older are unrelated to the normal part of aging. The quality of your later life is partly under your control. Choices about lifestyles and behaviors can influence the effects of so-called secondary aging.
Exercise and proper sleeping and eating habits will help your physical health, which will benefit your mental and cognitive health, Mr. Ludwig said.
People should prepare for the later stages of their life as they would starting a family or helping a child gain independence.
Seek financial advice to help adapt to changes in your income and plan for the costs of health care, Mr. Kaplan wrote. Discuss with your family and friends what you expect from old age and what type of lifestyle you desire.

Embrace the positives

Older adults are generally happier and less stressed and worried than middle-aged and young adults, Mr. Kaplan wrote.
Although there can be declines in health and income, “the vast majority of older adults enjoy improvements in the emotional aspects of life” because they are more focused on positive information, he wrote.
Mr. Ludwig said the reality of aging was not as bad as stereotypes would suggest.
While you might not be able to do all the things you once did when you were younger — he advises against playing tackle football with teenagers, for instance — there are ways you can compensate by finding other activities that are rewarding.
Find something to commit to improving, whether it’s tennis or cabinetry. Mr. Ludwig suggested focusing on helping others, especially younger people.
Remember, too, that you are not the only one feeling sore or slowing down, he said.
“There are millions of Americans waking up with those aches and pains,” Mr. Ludwig said. “What is the alternative to aging? It’s dying young.”

Reject ageist attitudes

Though it is true that as we age, we may gain some weight and lose some of our intellectual abilities, it is no reason to give in to stereotypes about older adults.
Myths about older people — that they are disconnected or crotchety — are perpetuated in the news media and our culture. Advancements in technology have accelerated the stereotype that older people can’t keep up, Mr. Ludwig said.
Leslie K. Hasche, an associate professor at the University of Denver Graduate School of Social Work, said she supported AARP’s “Disrupt Aging” initiative, which seeks to counter social and cultural myths about what it means to be old.
“Too often, the myths create barriers or limits, which get in the way of older adults staying connected or pursuing what is meaningful to them,” she wrote in an email.
Various milestones — birthdays, changes in careers and the deaths of siblings and peers — are reminders of the passage of time, but you should not lose focus on finding meaning and quality in life, Mr. Kaplan wrote.
“For many people, old age creeps up slowly and sometimes without fanfare or acknowledgment,” he wrote. “While most people enjoy relative continuity over the decades, being able to adapt to the changing context of our lives is the key to success throughout life.”

Tuesday, September 26, 2017

When Anxiety or Depression Masks a Medical Problem

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CreditPaul Rogers
It’s perfectly normal for someone to feel anxious or depressed after receiving a diagnosis of a serious illness. But what if the reverse occurs and symptoms of anxiety or depression masquerade as an as-yet undiagnosed physical disorder?
Or what if someone’s physical symptoms stem from a psychological problem? How long might it take before the true cause of the symptoms is uncovered and proper treatment begun?
Psychiatric Times, a medical publication seen by some 50,000 psychiatrists each month, recently published a “partial listing” of 47 medical illnesses, ranging from cardiac arrhythmias to pancreatic cancer, that may first present as anxiety. Added to that was another “partial listing” of 30 categories of medications that may cause anxiety, including antidepressants like selective serotonin reuptake inhibitors, or S.S.R.I.s.
These lists were included in an article called “Managing Anxiety in the Medically Ill,” meant to alert mental health practitioners to the possibility that some patients seeking treatment for anxiety or depression may have an underlying medical condition that must be addressed before any emotional symptoms are likely to resolve.
Doctors who treat ailments like cardiac, endocrine or intestinal disorders would do well to read this article as well lest they do patients a serious disservice by not recognizing an emotional cause of physical symptoms or addressing the emotional components of a physical disease.ontinue reading the main story
For example, Dr. Yu Dong, a psychiatrist at Inova Fairfax Hospital in Virginia, and colleagues pointed out last month that patients with respiratory conditions like asthma, sleep apnea or pulmonary embolism could present with symptoms of anxiety, or those with cardiac symptoms like chest pain or rapid heartbeat could have an anxiety disorder.
The problem of missing the proper diagnosis grows out of a long-ago separation of powers within the medical profession that often limits the ability of practitioners to see the forest for the trees, as it were. Medical doctors like cardiologists or gastro-enterologists are often ill-equipped to recognize and treat emotional symptoms related to a physical ailment, and psychiatrists may not consider the possibility that a patient with symptoms like palpitations, fatigue or dizziness really has a physical ailment.
Indeed, doctors at the Montreal Heart Institute reported in 1996 that about a quarter of 441 patients who came to the emergency room because of chest pain were in fact suffering from panic disorder, not a heart ailment. On the other hand, a woman I know who was being treated for panic attacks turned out to have a cardiac abnormality, and once that was corrected, her panic attacks disappeared.
Furthermore, anxiety is often overlooked as the source of disorders like substance abuse or addiction, or as a contributing factor to symptoms in conditions like migraine headache or irritable bowel syndrome.
The Mayo Clinic lists several factors that suggest the possibility that anxiety may result from an underlying medical disorder:
■ None of your blood relatives has an anxiety disorder.
■ You didn’t have an anxiety disorder as a child.
■ You developed anxiety seemingly out of the blue.
■ You don’t avoid certain things or situations because of anxiety.
Persistent anxiety can cause symptoms like dizziness, nausea, diarrhea and frequent urination. People suffering from anxiety disorders can develop an array of additional physical symptoms as well, like muscle pain, fatigue, headaches and shortness of breath, which can lead to all manner of costly tests in a futile search for a physical cause. Yet nearly a third of people with an anxiety disorder are never treated for it.
The problem affects children as well. Anxiety disorders in children may be expressed as recurrent stomachaches or sleep disorders, including frequent nightmares and teeth grinding.
When people have a chronic physical illness, untreated anxiety can make the symptoms worse and the disorder more difficult to treat. Among patients with chronic obstructive pulmonary disease, for example, untreated anxiety can result in more frequent hospitalizations and more severe breathing difficulties. And those with physical ailments and untreated anxiety are also more likely to die sooner.
Anyone with a chronic ailment who experiences symptoms common to anxiety might consider being checked out for this emotional component and getting treatment, if needed. There are several effective therapeutic approaches for anxiety, including cognitive-behavioral therapy and medication, that can result in a much improved quality of life.
Depression, too, can be an early sign of an underlying medical condition not yet recognized. Among conditions in which this has occurred are thyroid disease, heart attack, cancers of the lung and pancreas, and the adrenal disorder Cushing’s disease.
In a report in the journal Psychotherapy and Psychodynamics, researchers from Italy and Buffalo, pointed out that a neurological disorder like multiple sclerosis or Parkinson’s disease may first show up as a psychiatric problem years before neurological symptoms become apparent that result in a correct diagnosis.
They cited a study of 30 patients with multiple sclerosis at the University of Massachusetts Medical School, three-fourths of whom experienced a delay in diagnosis because they had symptoms of major depression.
“Physicians may not pursue medical work-up of cases that appear to be psychiatric in nature,” the team wrote. “They should be alerted that disturbances in mood, anxiety and irritability may antedate the appearance of a medical disorder.”
Thus, it may be up to patients themselves or their advocates to suggest to therapists that something other than an emotional problem may be responsible for psychiatric disturbances that don’t respond to standard psychiatric remedies.
Keep in mind that human beings are not divided into two different organisms: a physical one and an emotional one. Mind and body are a single construct with two-way communication, and what happens in the body below the head can — and often does — affect the brain and vice versa.
Medical practice has been slow to catch up with what was demonstrated by healers long before the advent of modern medical science. Although these healers may have had nothing to administer more potent than a placebo, they could sometimes successfully treat the body through the mind. Their patients expected the treatment to work, and so it often did.
Nowadays, when researchers study the effectiveness of a new treatment, they routinely include a control group that acts as a placebo to help determine the benefits of the remedy in question over and above those induced by a patient’s belief that the new remedy will work.

Sunday, September 3, 2017

On `Not Trying'


I recently competed in a very difficult athletic event.  I came up short.  Coming up short is a painful thing.  I struggle with the meaning of `failure.'

And that brought me to a true fact about our lives: when we don't try we never fail.  If we never fail we miss out on some painful but very important lessons.  Lessons that bring us closer to ourself and to one another.  

  • “No human ever became interesting by not failing. The more you fail and recover and improve, the better you are as a person. Ever meet someone who’s always had everything work out for them with zero struggle? They usually have the depth of a puddle. Or they don’t exist.” - Chris Hardwick

Trying at something builds our `stress' muscles.  When we struggle to accomplish something (a good relationship, patience, grace amidst setbacks, the virtue of altruism, learning something new, the exercise of restraint)
we travel over difficult ground.  We get knocked back sometimes.  We lose our way sometimes.  We find ourselves alone and frightened sometimes.  

  • “I have not failed. I've just found 10,000 ways that won't work.” - Thomas A. Edison

What we often don't recognize is that we build deeper empathy with others as a result of trying.  


The Characteristics of Emotional Maturity

Maturity: noun. 1. a being full-grown or ripe, 2. a being fully developed, complete, or ready, 3. a becoming due (Webster's New World Dictionary).

1. The ability to experience and understand our own deepest feelings and needs, and to be able to act on and express these feelings and needs in appropriate and constructive ways. This is opposite from "acting-out" our needs in unconscious, destructive patterns of behavior. This aspect of maturity includes the ability to experience and tolerate especially intense feelings - which inevitably occur in life - and to be able to appropriately express these feelings, or contain them until an appropriate and responsible means for expressing them is available.

2. The ability to act on and react to life circumstances with intelligence, sound judgment and wisdom. This aspect of maturity is opposite the tendency to act impulsively, without taking the opportunity to think through our actions or consider their consequences. (Wisdom: having the quality of good judgment, learning and erudition, soundness.)

3. The ability to recognize, empathize with, and respect the feelings and needs of others. This is opposite from a selfish and chronic preoccupation with our own needs, with no awareness of, or sensitivity to, the needs of others.

4. The ability to delay the immediate satisfaction of our own needs, so that we may attend to other more pressing needs or actions. This is opposite from a condition in which our immediate needs always take precedence over all other needs.

5. The ability to love - to allow another's needs, feelings, security, and survival to be absolutely paramount - just as if these were our own.

6. The ability to adapt flexibly and creatively to life's changing circumstances and conditions. This is distinct from the tendency to respond to life's challenges in rigid, outmoded behavior patterns that are no longer particularly effective or appropriate.

7. The ability to channel our energy, both positive and negative, into constructive contributions to ourselves, to others, and to our communities.

8. The willingness and ability to be responsible and accountable for our own circumstances and actions in life, and the ability to differentiate our responsibilities from those of others. This is distinct from blaming others and seeing ourselves primarily as the victim of other's behavior, or from maintaining a sense that we are somehow responsible for the happiness and well-being of all those around us. Responsibility arises from a stance of strength and competence; it does not include pronouncements of blame, shame, guilt, or moral inferiority/superiority, as all these are judgments added to the basic condition of responsibility.

9. The ability to relate comfortably and freely with others, to like and be liked by others, and to maintain healthy and mutually satisfying relationships.

10. The ability to choose and develop relationships that are healthy and nurturing, and to end or limit relationships that are destructive or unhealthy.

©Maryland Institute, 1998