Blame the Illness, Not the Patient

One of the most hurtful comments made to me during the worst of my depression was this: "You must not want to get better."

I'm having a hard time forgiving the person who said that, even as I know she didn't intend to be spiteful or mean. She's just plain ignorant regarding mental health issues.

Comments like that are why I'm so passionate about educating folks on mental illness and eliminating the isolating stigma of our condition. Because it's hard enough fighting all the negative intrusive thoughts within our head. We don't need additional insults and negative opinions--confirmation of our weakness--from folks who have never wanted to die and consider all suicidal thoughts self-absorbed and pathetic.

But boy do we hear a lot of them, even from the persons who are supposed to be on our side: our doctors and psychotherapists.

Richard Friedman, M.D. penned a compelling, salient piece for the New York Times a few weeks ago (thanks to my editor Holly for forwarding it to me, since I don't read anymore) on why so many doctors and psychotherapists blame their patients if they don't get better. It beats blaming themselves!

Friedman writes:

Doctors and psychotherapists generally don't like it when their patients don't get better. But the fact is that lots of patients elude our clinical skill and therapeutic cleverness. That's often when the trouble starts.

I met one such patient not long ago, a man in his early 30s, who had suffered from depression since his teenage years. In six years of psychotherapy, he had been given nearly every antidepressant under the sun, but his mood hadn't budged.

Weeping in my office one day, he explained that he was depressed because he was a failure and a whiner. "Even my therapist agreed with me," he said. "She said that maybe I don't want to get better."

You can't see me, but I'm nodding right now, as I read that. Because I've been there, done that, bought the t-shirt, and shrank it in the wash. I can honestly say that my current doctor, number seven, is the only psychiatrist who didn't look at me with some speck of skepticism in her eye, as if I might be playing sick to prove that she should have never graduated from med school when she doesn't know a thing about the brain, or how she and the entire field of psychiatry is a sham--a well-contrived conspiracy to get the people's money, or that I just was on a mission to make her miserable. Because ... I have nothing else to do?

One therapist told me that he knew people who wanted to get well, and he knew people who wanted to stay sick. It's no wonder, then, that he couldn't understand why I lost control of myself during a panic attack, why I couldn't access that "happy place" in my brain, to stop me from shaking, losing my grip of the steering wheel, and ultimately finding myself with a flat tire up on the curb of main road in Annapolis. In retrospect I know exactly why that happened: I wanted to stay sick!

Thank God for doctors like Friedman and Dr. Smith who honestly get it--they realize that their patients don't get anything out of misery. In fact, the misery is miserable! Dr. Smith has never once looked at me with scorn after I've had a setback--like I framed it to get on more Zoloft because that drug is sooo good for my sex life.

The patient that Friedman described above finally responded to a treatment. Free from his depression, the guy no longer felt like a failure. Friedman writes:

I decided to challenge him. "How come you're feeling so much better despite the fact that nothing in your life has really changed in the past few weeks?"

"Well, I guess I just think like that when I'm down."

Exactly. His sense of worthlessness was a result of his depression, not a cause of it. It's easy to understand why the patient couldn't see this: depression itself distorts thinking and lowers self-esteem. But why did his therapist collude with the patient's depressive symptoms and tell him, in effect, that he didn't want to get better?

For an all too human reason, I think. Chronically ill, treatment-resistant patients can challenge the confidence of therapists themselves, who may be reluctant to question their treatment; it's easier -- and less painful -- to view the patient as intentionally or unconsciously resistant.

Friedman goes on to say that he believes that some patients do really want to be sick. According to Friedman, some "go to extraordinary means to defeat doctors who try to 'treat' them."

I don't think the patient wants to defeat the doctor. I think he is merely too sick to get well, meaning he can't do all the hard work that's required to maintain recovery when his feet are cemented in his disease. That cycle--which I know all too well--is a pernicious one that I no longer judge.

Or maybe some folks are just more driven and more disciplined to get to Sanity Island. Either way, I'd like to blame the illness, not the patient. Friedman does, for the most part, too. He concludes the article with this: "A vast majority of patients want to feel better, and for them the burden of illness is painful enough. Let's keep the blame on the disease, not the patient."

Amen.

9 Ways to Face Your Fears

Fears are like annoying relatives. You can't avoid them forever, and ignoring them won't make them go away. Come Thanksgiving, they'll plop down right next to you and ask to borrow your fork. So you'd better figure out how to confront the little devils before they eat your dessert too. Here are a few fun ideas for how to tell your fears to hit the bricks.

Yell at Them

Tell them to go to a place where there are no lemonade stands.

Laugh at Them

A good technique: start with "ha" and end with "hee."

Talk About Them

Preferably to a friend, over a cup of strong coffee.

Scare Them Away

Any mask will do, but any beast or vampire getup is particularly effective.

Dress Them Up

With the right attire and hairdo, you can make anything seem attractive and desirable (to someone else), right?

Harness Them

If they are under your control, you don't have to worry about them.

Interrogate Them

Ask them the hard questions, including: where, what, why, when, and how? Then get a mug shot.

Bully Them

Boss them around like the scary dude in the fifth grade who made you cry. You're bigger than they are --don't let them forget it.

Free Them

Let them go. Tell them to have fun, but not to come back.

Is Grief a Mental Disorder?

On Fridays I will address a question related to depression and find the answer from an expert. If you have a question you want answered, please ask it on the combox of this post, and I'll try my best to do some research and feature it in an upcoming Friday post.

A few Fridays ago, I asked the question: How is depression different from sadness? And I excerpted from a New York Times article written by Dr. Ron Pies, professor of psychiatry at Tufts and SUNY Upstate Medical Center in Syracuse. I was delighted to see him post a comment to my blog. He wrote:

To all who have commented on my New York Times piece, I would urge you to take a look at my much more detailed (and perhaps clearer!) explanation on the PsychCentral website. You can find it by clicking here.

In essence: Grief is not a disease, but it can become one. The issue is not whether we can point to a "cause" for someone's depressive symptoms, or whether we judge their reaction to be "normal" (from our own personal perspective). The issue is to what degree the person is suffering and incapacitated--whether or not we can point to some loss or other supposed "cause" for the way they feel. When suffering and incapacity become very great, the person merits professional help. This need not involve medication--but it does mean a careful evaluation and perhaps "talk therapy." In some cases, an antidepressant may also be helpful. There is no evidence that such professional help "interferes" with grieving or mourning, so long as the person is seeking help.

I appreciate his taking the time to write Beyond Blue readers, and inform us of his other piece, which allows more context to this very complicated subject. So here's this Friday's question: Is grief a mental disorder? I urge you to read the entire piece. Here's an excerpt:

I recently had an essay published in the New York Times (9/16/08), in which I argued that the line between profound grief and clinical depression is sometimes very faint. I also argued against a popular thesis that says, in effect, "If we can identify a very recent loss that explains the person's depressive symptoms -- even if they are very severe -- it's not really depression. It's just normal sadness."

In my essay, I presented a hypothetical patient -- let's call him Jim -- who was based on many patients I've seen in my psychiatric practice. Jim comes to me complaining of "feeling down" for the past three weeks. A month ago, his fiancée left him for another man, and Jim feels that "There's no point in going on" with life. He has not been sleeping well, his appetite is poor and he has lost interest in nearly all of his usual activities.

I deliberately withheld a lot of important information that any well-trained psychiatrist, psychologist, or psychiatric social worker would obtain. For example: in the past three weeks, had Jim lost a great deal of weight? Was he awakening regularly in the wee hours of the morning? Was he unable to concentrate? Was he extremely slowed down in his thinking and movement (so-called "psychomotor retardation"). Did he lack energy? Did he see himself as a worthless person? Did he feel completely hopeless? Was he filled with guilt or self-loathing? Had he been unable to go to work or function well at home, over the past three weeks? Did he have any actual plans to end his life?

I wanted to make the case ambiguous enough to be suggestive of clinical depression without "clinching" the diagnosis by providing answers to all these questions. (A "yes" answer to most of these questions would point to a serious bout of major depression).

But even given the limited information in my scenario, I concluded that people like Jim were probably better understood as "clinically depressed" than as "normally sad." I argued that individuals with Jim's history merited professional treatment. I even had the temerity to suggest that some grieving or bereaved individuals who also show features of a major depression may benefit from antidepressant medication, citing the research of Dr. Sidney Zisook. (If I had to write the piece all over again, I would have added, "Brief, supportive psychotherapy alone may do the job for many people with Jim's symptoms").

Well, my goodness! The blogosphere lit up like a swarm of fireflies. You would think that I had advocated the killing of the first-born! I should not have been surprised by the reaction from the "Hate Psychiatry First" crowd, who get their information about psychiatry from Tom Cruise. They wrote me off as either a shill for the drug companies [see disclosure], or someone who was "declaring grief to be a disease." One of the most irate bloggers opined that my medical license should be revoked!

Healthy Thanksgiving Recipes

Thanksgiving is all about abundance, or, often, overabundance. But it doesn't have to be that way. With healthy updates to classic dishes, the recipes showcased here use high-impact flavors like fresh herbs, spices and seasonal fruits and vegetables to minimize the need for gobs of butter, cream and salt.

If you're not hosting this year, choose from our selection of healthy sides and scrumptious desserts. Enjoy a delicious, healthy Thanksgiving!

Herb-Roasted Turkey

This method produces all the good looks and moist flavor you dream of in a Thanksgiving turkey. Make sure you show this beauty off at the table before you carve it. Garnish your serving platter with fresh herb sprigs and citrus wedges.

Makes 12 servings, 3 ounces each, plus plenty of leftovers

ACTIVE TIME: 30 minutes

TOTAL TIME: 3 1/2 hours

EASE OF PREPARATION: Easy

• 1 10- to 12-pound turkey
• 1/4 cup minced fresh herbs plus 20 whole sprigs, such as thyme, rosemary, sage, oregano and/or marjoram, divided
• 2 tablespoons canola oil
• 1 teaspoon salt
• 1 teaspoon freshly ground pepper
• Aromatics: onion, apple, lemon and/or orange, cut into 2-inch pieces (1 1/2 cups)
  
• 3 cups water, plus more as needed

1. Position a rack in the lower third of the oven; preheat to 475 degrees.

2. Remove giblets and neck from turkey cavities and reserve for making gravy. Place the turkey, breast-side up, on a rack in a large roasting pan; pat dry with paper towels. Mix minced herbs, oil, salt and pepper in a small bowl. Rub the herb mixture all over the turkey, under the skin and onto the breast meat. Place aromatics and 10 of the herb sprigs in the cavity. Tuck the wing tips under the turkey. Tie the legs together with kitchen string. Add 3 cups water and the remaining 10 herb sprigs to the pan.

3. Roast the turkey until the skin is golden brown, 45 minutes.

Remove the turkey from the oven. If using a remote digital thermometer, insert it into the deepest part of the thigh, close to the joint. Cover the breast with a double layer of foil, cutting as necessary to conform to the breast. Reduce oven temperature to 350 degrees and continue roasting for 11/4 to 13/4 hours more. If the pan dries out, tilt the turkey to let juices run out of the cavity into the pan and add 1 cup water. The turkey is done when the thermometer (or an instant-read thermometer inserted into the thickest part of the thigh without touching bone) registers 165 degrees.

4. Transfer the turkey to a serving platter and cover with foil. (If you're making Herbed Pan Gravy, start here.) Let the turkey rest for 20 minutes. Remove string and carve.

NUTRITION INFORMATION: Per serving (without skin): 155 calories; 5 g fat (1 g sat, 2 g mono); 63 mg cholesterol; 0 g carbohydrate; 25 g protein; 0 g fiber; 175 mg sodium; 258 mg potassium. 0 Carbohydrate Servings

Herbed Pan Gravy

The giblets and neck from a turkey make a great flavorful stock that helps ensure a rich, tasty gravy, but you may substitute more chicken broth if you prefer.

Makes about 3 cups

ACTIVE TIME: 20 minutes

TOTAL TIME: 1 hour 20 minutes (includes making stock, Step 1)

EASE OF PREPARATION: Easy

• Giblets and neck from turkey
• 6 cups water
• 2-3 cups reduced-sodium chicken broth, divided
• 1/4 cup all-purpose flour
• 3/4 cup deglazing liquid, such as white wine, vermouth or brandy
• 1 tablespoon minced fresh herbs (optional)
• Salt & freshly ground pepper to taste

1. To make giblet stock: Place giblets (except liver), neck and water in a large saucepan. (Reserve the liver for another use or discard.) Bring to a boil over high heat. Reduce heat and simmer, skimming and discarding any foam, for 1 hour. Strain through a fine-mesh sieve.

2. To make gravy: After removing the turkey from the roasting pan, pour any pan juices and fat into a large glass measuring cup and place in the freezer so the fat rises to the top, about 10 minutes. Skim the fat off with a spoon and discard. (Alternatively, pour the pan juices and fat into a fat separator then pour the defatted juices into a large measuring cup.) Add any accumulated juices from the resting turkey to the defatted pan juices; add the reserved giblet stock plus enough chicken broth so the combined liquids measure 5 cups total.

3. Whisk 1/2 cup chicken broth and flour in a small bowl until smooth.

4. Set the roasting pan over two burners on medium-high heat. Add deglazing liquid; bring to a boil and cook, scraping up the browned bits from the pan, until the liquid is reduced, about 3 minutes. Add the 5 cups of liquid from Step 2. Increase the heat to high and return to a boil, whisking often and scraping up any remaining browned bits. Boil until reduced to 2 3/4 cups, 8 to 12 minutes. Whisk the reserved broth-and-flour mixture into the roasting pan. Boil, whisking constantly, for 2 to 3 minutes. Remove from the heat and pour the gravy through a fine sieve into a large measuring cup. Stir in herbs, if using. Taste and season with salt (if needed) and pepper.

NUTRITION INFORMATION: Per 3-tablespoon serving: 34 calories; 2 g fat (1 g sat, 1 g mono); 2 mg cholesterol; 2 g carbohydrate; 1 g protein; 0 g fiber; 56 mg sodium; 11 mg potassium. 0 Carbohydrate Servings. Exchanges: 1/2 fat.

Pear, Prosciutto & Hazelnut Stuffing

Crisping the prosciutto and toasting the nuts adds a powerful punch of flavor to the stuffing without going overboard on fat. Diamond Brand now makes packaged chopped hazelnuts, available in most major supermarkets.

Makes 12 servings, 2/3 cup each

ACTIVE TIME: 1 hour

TOTAL TIME: 2 1/4 hours

EASE OF PREPARATION: Easy

• 3 teaspoons extra-virgin olive oil, divided
• 4 ounces thinly sliced prosciutto, cut into ribbons
• 2 cups chopped onion
• 2 cups diced fennel bulb
• 1/4 cup minced shallot
• 2 teaspoons minced fresh sage
• 2 teaspoons minced fresh thyme
• 1 teaspoon minced fresh rosemary
• 8 cups stale baguette, preferably multi-grain (not sourdough), cut into 1/2-inch cubes (see Note)
• 2 ripe but firm Bosc pears, chopped
• 1/3 cup chopped flat-leaf parsley
• 1/3 cup toasted chopped hazelnuts (see Tip)
• 1 14-ounce can reduced-sodium chicken broth
• 1/4 teaspoon salt
• Freshly ground pepper to taste

1. Preheat oven to 350 degrees. Coat a 9-by-13-inch baking dish with cooking spray.

2. Heat 1 teaspoon oil in a large nonstick skillet over medium heat. Add prosciutto; cook, stirring, until crispy, about 5 minutes. Drain on a paper towel.

3. Wipe out the pan and heat the remaining 2 teaspoons oil over medium-high heat. Add onion, fennel and shallot and cook, stirring, until softened and beginning to brown, 6 to 8 minutes. Add sage, thyme and rosemary and cook, stirring, for 1 minute more. Transfer everything to a large bowl and gently stir in bread, pears, parsley, hazelnuts and the prosciutto. Add broth; toss to combine. Season with salt and pepper. Spoon the stuffing into the prepared baking dish; cover with foil.

4. Bake for 40 minutes; remove the foil and bake until the top is beginning to crisp, 25 to 30 minutes more.

NUTRITION INFORMATION: Per serving: 176 calories; 5 g fat (1 g sat, 2 g mono); 8 mg cholesterol; 29 g carbohydrate; 9 g protein; 6 g fiber; 489 mg sodium; 283 mg potassium. Nutrition bonus: Vitamin C (20% daily value). 1 1/2 Carbohydrate Servings. Exchanges: 1 1/2 starch, 1 vegetable, 1/2 fat

TIP: To toast chopped nuts & seeds: Cook in a small dry skillet over medium-low heat, stirring constantly, until fragrant and lightly browned, 2 to 4 minutes. Ingredient note: If you don't have stale bread ready to use, spread the baguette cubes on a baking sheet and toast at 250 degrees until crisped and dry, about 15 minutes.

Sizzled Green Beans with Crispy Prosciutto and Pine Nuts

Sizzling green beans in a little oil helps to bring out their natural sweetness. Prosciutto, pine nuts and lemon zest dress up the flavor without adding a lot of fat - a nice alternative to full-fat, creamy green bean casseroles.

Makes 8 servings, 3/4 cup each

ACTIVE TIME: 30 minutes

TOTAL TIME: 45 minutes

EASE OF PREPARATION: Easy

• 2 pounds green beans, trimmed
• 2 1/2 teaspoons extra-virgin olive oil, divided
• 2 ounces thinly sliced prosciutto, cut into ribbons
• 4 cloves garlic, minced
• 2 teaspoons minced fresh sage
• 1/4 teaspoon salt, divided
• Freshly ground pepper to taste 1/4 cup toasted pine nuts (see Tip)
• 1 1/2 teaspoons freshly grated lemon zest
• 1 teaspoon lemon juice

1. Bring a large pot of water to a boil. Add beans, return to a boil, and simmer until crisp-tender, 3 to 4 minutes. Drain.

2. Heat 1/2 teaspoon oil in a large nonstick skillet over medium heat. Add prosciutto; cook, stirring, until crispy, 4 to 5 minutes. Drain on a paper towel.

3. Wipe out the pan; heat the remaining 2 teaspoons oil over medium heat. Add the beans, garlic, sage, 1/8 teaspoon salt and several grinds of pepper. Cook, stirring occasionally, until the beans are browned in places, 3 to 4 minutes. Stir in pine nuts, lemon zest and the prosciutto. Season with lemon juice, the remaining 1/8 teaspoon salt and pepper.

NUTRITION INFORMATION: Per serving: 99 calories; 5 g fat (1 g sat, 2 g mono); 6 mg cholesterol; 10 g carbohydrate; 5 g protein; 4 g fiber; 264 mg sodium; 196 mg potassium. Nutrition bonus: Vitamin C (20% daily value), Fiber (16% dv), Vitamin A (15% dv). 1 Carbohydrate Serving. Exchanges: 2 vegetable, 1 fat.

TIP: To toast chopped nuts & seeds: Cook in a small dry skillet over medium-low heat, stirring constantly, until fragrant and lightly browned, 2 to 4 minutes.

Gingered Cranberry-Raspberry Relish

To make ahead: Cover and refrigerate for up to 1 week.

Makes about 4 cups

ACTIVE TIME: 10 minutes

TOTAL TIME: 3 hours 10 minutes (including chilling time)

EASE OF PREPARATION: Easy

• 1 12-ounce package fresh cranberries
• 1/2 cup granulated sugar
• 1/2 cup minced crystallized ginger (choose soft nuggets over disks, if possible)
• 3 cups raspberries (2 pints), fresh or frozen (not thawed)

Pulse cranberries in a food processor until coarsely chopped. Transfer to a medium bowl. Stir in sugar and crystallized ginger. Gently stir in raspberries, it's fine to crush some of them. Cover and refrigerate for at least 3 hours to let the flavors combine.

NUTRITION INFORMATION: Per 1/4-cup serving: 58 calories; 0 g fat (0 g sat, 0 g mono); 0 mg cholesterol; 15 g carbohydrate; 0 g protein; 2 g fiber; 2 mg sodium; 53 mg potassium. Nutrition bonus: Vitamin C (15% daily value). 1 Carbohydrate Servings. Exchanges: 1 other carbohydrate.

Mashed Roots with Buttermilk & Chives

Mashed Roots with Buttermilk & Chives
This chunky mash has a clean earthy taste enhanced by sweet garlic and tangy buttermilk. Even if you've seldom cooked with root vegetables like celery root or rutabaga, don't hesitate to try this recipe - it's delicious!

Makes 8 servings, 3/4 cup each

ACTIVE TIME: 20 minutes

TOTAL TIME: 1 hour

EASE OF PREPARATION: Easy

• 2 pounds celery root, peeled and cut into 1-inch pieces
• 1 pound rutabaga, peeled and cut into 1-inch pieces
• 1 pound Yukon Gold potatoes, peeled and cut into 1-inch pieces
• 5 cloves garlic, peeled
• 4 tablespoons unsalted butter, divided
• 3/4 cup nonfat buttermilk
• 1/2 teaspoon salt
• 1/4 teaspoon freshly ground pepper
• 1/4 teaspoon ground nutmeg
• 1/3 cup snipped fresh chives

1. Bring 1 inch of water to a simmer in a large pan or Dutch oven. Place celery root, rutabaga and potatoes in a large steamer basket over the water, cover and steam over medium-low heat for 20 minutes. Add garlic and continue steaming-checking the water level and replenishing as necessary-until the vegetables are fall-apart tender, 20 minutes more.

2. Remove the vegetables, drain the cooking liquid and return the vegetables to the pan. Add 2 tablespoons butter and mash until chunky-smooth. Gradually stir in buttermilk, salt, pepper and nutmeg.

3. Just before serving, stir in the remaining 2 tablespoons butter and chives.

NUTRITION INFORMATION: Per serving: 167 calories; 6 g fat (4 g sat, 0 g mono); 15 mg cholesterol; 25 g carbohydrate; 4 g protein; 4 g fiber; 274 mg sodium; 779 mg potassium. Nutrition bonus: Vitamin C (35% daily value), Potassium (22% dv). 1 1/2 Carbohydrate Servings. Exchanges: 1 starch, 1 vegetable, 1 fat.

Glazed Chocolate-Pumpkin Bundt Cake

You don't have to have pumpkin pie to still enjoy pumpkin and spice in a Thanksgiving dessert. This tender, moist cake uses pureed pumpkin to replace much of the fat and is delicately seasoned with classic Thanksgiving flavors.

Makes 16 servings

ACTIVE TIME: 30 minutes

TOTAL TIME: 3 1/2 hours (including cooling time)

EASE OF PREPARATION: Easy

Cake

• 1 cup all-purpose flour
• 3/4 cup whole-wheat pastry flour
• 1 cup granulated sugar
• 3/4 cup unsweetened cocoa powder (not Dutch-process)
• 1 1/2 teaspoons baking powder
• 1 1/2 teaspoons baking soda
• 1 teaspoon pumpkin pie spice
• 1/4 teaspoon salt
• 1 cup nonfat buttermilk
• 1 15-ounce can unsweetened pumpkin puree
• 3/4 cup packed dark brown sugar
• 1 large egg, at room temperature (see Tip)
• 1 large egg white, at room temperature
• 1/4 cup canola oil
• 1/4 cup light corn syrup
• 1 tablespoon vanilla extract

Glaze & Garnish

• 1/2 cup packed confectioners' sugar
• 1 tablespoon nonfat buttermilk
• 2 tablespoons mini chocolate chips or toasted chopped nuts (see Tip)

1. To prepare cake: Preheat oven to 350 degrees. Coat a 12-cup Bundt pan with cooking spray.

2. Whisk all-purpose flour, whole-wheat flour, granulated sugar, cocoa, baking powder, baking soda, pumpkin pie spice and salt in a medium bowl.

3. Blend 1 cup buttermilk, pumpkin puree and brown sugar in a large bowl with an electric mixer on low speed. Beat in whole egg and egg white. Stir in oil, corn syrup and vanilla. Gradually add the dry ingredients, stirring until just combined. Transfer the batter to the prepared pan.

4. Bake the cake until a wooden skewer inserted in the center comes out with only a few moist crumbs attached, 1 to 1 1/4 hours. Let cool on a wire rack for 15 minutes. Remove from the pan and let cool completely on the rack, about 2 hours.

5. To glaze & garnish cake: Combine confectioners' sugar and 1 tablespoon buttermilk in a small bowl, stirring until completely smooth. Place the cake on a serving plate and drizzle the glaze over the top; garnish with chocolate chips (or chopped nuts) while the glaze is still moist.

NUTRITION INFORMATION: Per serving: 234 calories; 5 g fat (1 g sat, 3 g mono); 13 mg cholesterol; 46 g carbohydrate; 4 g protein; 3 g fiber; 238 mg sodium; 159 mg potassium. Nutrition bonus: Vitamin A (80% daily value). 3 Carbohydrate Servings. Exchanges: 3 other carbohydrate, 1 fat.

Riesling Baked Pears

Here's an elegant yet simple twist on the autumn classic. Pears are oven-poached in Riesling wine, which is known for its floral accents and aromas and hints of honey and pear. Serve this dessert with lightly sweetened ricotta cheese. Delicious hot, room temperature or chilled.

Makes 4 servings

ACTIVE TIME: 20 minutes

TOTAL TIME: 1 hour 20 minutes

EASE OF PREPARATION: Easy

• 4 ripe pears, preferably Bosc, with stems, washed and dried
• 2 cups Riesling or other fruity white wine
• 1/4 cup honey
• 4 cinnamon sticks
• 4 bay leaves
• 4 strips orange zest (see Tip)

1. Preheat oven to 400 degrees.

2. Cut a thin slice off the bottom of each pear, so they will stand upright. Arrange the pears in a 9- to 10-inch pie pan or similar baking dish. Whisk wine and honey in a medium bowl until well blended; pour over the pears. Add cinnamon sticks, bay leaves and orange zest to the wine mixture around the pears.

3. Roast the pears, basting every 15 minutes, until they are wrinkled and tender, 45 minutes to 1 hour, depending on the type of pear used.

4. Use a slotted spoon to transfer the pears to shallow dessert bowls. Pour the wine mixture into a small saucepan; bring to a boil. Boil until slightly thickened, about 6 minutes. Drizzle over the pears and garnish with the cinnamon sticks, bay leaves and orange zest. Serve warm, at room temperature or chilled.

NUTRITION INFORMATION: Per serving: 241 calories; 0 g fat (0 g sat, 0 g mono); 0 mg cholesterol; 43 g carbohydrate; 1 g protein; 4 g fiber; 2 mg sodium; 176 mg potassium. 3 Carbohydrate Servings. Exchanges: 1 fruit, 2 other carbohydrate

Multifaith Mealtime Prayers

If food is for the nourishment of our bodies, then prayer must be for the nourishment of our souls. And what better appetizer to a delicious meal could there be than a prayer of gratitude?

Gratitude for God's Goodness

Jewish

Praised are You, our God, Ruler of the universe, who in goodness, with grace, kindness, and mercy, feeds the entire world. He provides bread for all creatures, for His kindness is never-ending. And because of His magnificent greatness we have never wanted for food, nor will we ever want for food, to the end of time.

For His great name, because He is God who feeds and provides for all, and who does good to all by preparing food for all of His creatures whom He created: Praised are You, God, who feeds all.

--likemike

Giving Thanks

Christian

Thank you, Father, for bread and meat.
Thank you for the friends we meet.
Thank you for our moms and dads.
Thank you for the love we have.
Thank you for our work and play.
Thank you for another day.
In Jesus' name, Amen.

--billybud

Dedicating Food

Buddhist

May this food be dedicated to the
triple jewel:
The precious Buddha
The precious Dharma
The precious Sangha


Bless this food so we may take it
as medicine
Free from attachment and desire
So that it may nourish our bodies
So we may work for the benefit of all
sentient beings.

--DrunkenMoon

Praise to Allah for Sufficiency

Muslim

"All praises are due to Allah who gave us sufficient food to eat and who satiated our thirst while such food is needed (by us) all the time and while we are not ungrateful (to Allah)."

--Noggin786

Blessing Over Bread

Earth-based

Mother of Plenty, bless this bread
Father of the Grain, lend your seed
Let it nourish heart and head
Let it nourish thought and deed
Let its breaking be a spell
That hungry mouths be fed as well
And let its eating keep us free
As is our will
So mote it be!

--vie13

For Fruits of the Earth

Earth-based

Blessed be the Earth for giving birth to this food
Blessed be the Sun for nourishing it
Blessed be the Wind for carrying
its seed
Blessed be the Rain for quenching
its thirst.

Blessed be the hands that helped to grow this food,
To bring it to our tables
To nourish our minds, bodies,
and spirits.

Blessed be our friends, our families, and our loved ones.
Blessed Be.

--Magdalen6

Thanking the Great Spirit

Native American

We thank the Great Spirit for the resources that made this food possible; we thank the Earth Mother for producing it, and we thank all those who labored to bring it to us. May the wholesomeness of the food before us, bring out the wholeness of the Spirit within us.

--revwhiteeagle

Thanks We Offer

Multifaith

Heavenly Father, kind and good,
Thanks we offer for this food;
For Thy love and tender care,
For all the blessings that we share.
Amen.

--MCWinters

Mindful Monday: Beware of Facebook

On Mindful Monday, my readers and I practice the art of pausing, TRYING to be still, or considering, ever so briefly, the big picture. We're hoping this soul time will provide enough peace of mind to get us through the week!

Something transpired in the last two days that I'm almost too embarrassed to write about, and, considering I've published all the details of my sex life ... well, it's bad.

It's Facebook.

I joined.

Two days ago. After I swore to myself this summer I would never do such a thing.

And I haven't been able to sleep since.

I've totaled five hours in two nights.

As soon as my eyes close, I envision friend after friend that I need to befriend or else something horrible will happen. The friend with more friends will take over Beyond Blue! Because everyone likes her better! Duh! She has more friends! Unless I steal her friends .... when she's not online!

It's high school all over again. But uglier, because now you have all your worlds colliding: friends with colleagues, ex-bosses with in-laws, ex-boyfriends with sisters, former colleagues with babysitters! It's one big orgy on the internet. No rules. No boundaries. Tell me what you're thinking. Don't hold back. Okay, I won't.

Within an hour of signing up, I was so click happy I thought I had a tick in my right index finger, or I was a slot-machine junkie that couldn't break the habit of seeing what I get next time. I clicked all the friends of friends, and then their friends. I mean, my God! There are important folks here--senior writers at Time Magazine (he accepted!), Anne Rice (she accepted!), NYT journalists! (still pending)--here, right at your finger tip! And THEY DON'T HAVE ASSISTANTS TO WEED YOU OUT! Here in this magical kingdom--where we have concealed conversations that those non-Facebook folks aren't privy to--there is no assistant with attitude who wants to know EXACTLY what you are calling about and how you know Mr. Smith. Nope, in this secret world where people can network and laugh and find babysitters, you have a shot at becoming a friend of a big cheese, and once he is in your friend file, you can go after his elite friends who will see that their buddy befriended you so you must not be crazy (ha!) and will accept your friendship invitation. It's like the pyramid model for networking.

I must have clicked over 500 invitations the first day on Facebook, and only one lady played hard to get. She wrote: "Hi Therese, Just gut a note from you and I see you and I have some Beliefnet friends in common. Do we know each other? I've been getting some spam through Facebook, so just wanted to be safe."

I responded: "Hey. Nope. I don't think we know each other. We had friends in common, and I just started my account today, so I was a little click happy ... if you know what I mean. You looked nice. How's that for pathetic?"

By the end of the day, my very first day of Facebook, I had 50 friends! Of course I spent four hours acquiring them. I slept three hours that night, during which I dreamt that I attended a wedding where I was being introduced to all the friends of one of my friends, and his relatives and in-laws. "So nice to meet you."

The second day wasn't so pretty.

At lunch, after I had spent a good two hours at the magical kingdom, Eric came home to me in tears.

"It's Facebook, isn't it?" he asked. "Like I couldn't see this coming." He pulls out a can of black bean soup and explains his theory on why Facebook and my brain can't be friends.

"These sites weren't made for people like you. Facebook combines every one of your addictions and pulls you into a world that will destroy you if you're not careful. Do you really have to know what the roommate of the girl who lived down the hall from you ate for breakfast this morning and how she popped a zit on the way to work? How can you benefit from that knowledge?"

I got some toilet paper and sniffed. Then I called my friend Priscilla, whom I met online.

"I don't think I can do Facebook anymore," I said, sniffing. "It's too overwhelming for me. I turn into a rat. And I chase the rat in front of me even though she doesn't know where the hell she's going. But I chase her anyway because she has 422 friends, and her blog is syndicated on The Huffington Post, so she must be successful."

Priscilla laughed. "All right. Let's look at this. ....It doesn't have to be all or nothing. You just need a system that will allow you to get what you need done--networking, publicizing--and to keep out all the chatter that's going to have you back at Johns Hopkins psych unit. So grab a pencil and write this down where you can see it: Facebook is not an interactive, social adventure for me. It's a professional organization to get media contacts and possible work down the road. It is not a place where I solve other people's problems. It's not a place to feed my soul and get all those affirmations I crave. It is not a place to develop my self-esteem.

I've written this down. I get it. But for the moment, I'm still a rat. Chasing another rat with more friends.

LEMON: Antidote to What Ails You

While we might believe that life is a linear journey, for most of us, it is a circuitous event. There are hills, valleys, twists and turns, set backs and leaps forward. There are the 'plum' experiences, and then, there are the 'lemons.'

We love the delicious plums, don't we? Sweet and juicy! They're easy to embrace and enjoy.

The lemons of life are actually more of a challenge, yes? And with challenge comes opportunity for change. YAY!!! We love opportunity!!! (Feeling more excited about the lemons in your life, already, yes?)

Now, I don't know what is going on in your life, but I am going to out on a limb and presume that there is at least one 'lemon' floating through it. One 'lemon' that you can, today, transform into a glass of delicious, soul satisfying lemonade.

What is a lemon?

A lemon is a citrus fruit whose exact origins remain a mystery, although it is widely believed that lemons first grew in India, northern Burma and China. In South and Southeast Asia lemons were primarily know for their antiseptic properties, and they were used as an antidote for various poisons.

A lemon can be your antidote to what ails you.

For instance, we were planning on a vacation but the economy threw us (hurled and hit is more like it) a lemon the size of a grapefruit. Instead of going to some exotic place, we are staying home. Now, I could suck on that lemon and feel like something was taken away from me ... or I can add ingredients to the lemon and turn it around.

What to do? I made a list of all my in-town friends, put together a list of free events in the city, and I invited some to one event; some to another - hosted a potluck dinner at my house and had the best time connecting with friends with whom I otherwise struggle to find time to see. I filled my week with fun activities and fabulous friends. Truthfully, in lots of ways, it was better than a trip! No jet lag involved!!!

In keeping with the theme (you know, I do LOVE a theme!), I whipped up a blender full of lemonade for everyone! Here's my recipe!

Keeping It Healthy - Lemonade. Instead of using sugar in your lemonade recipe, substitute 4 apples to 1/4 lemon, peel and all! Through into your food processor. Wowzer. Lemonade without sugar!!!! How exciting is that????

Spread the word ... NOT the icing!

10 Steps to Turning Your Life Around

Discover all the positive things life has in store for you by moving up and moving forward today.

Up is the movement and direction toward possibility--"with God nothing is impossible." Up is the movement of reaching. Up is where we're going. When you watch birds take off, they don't fly down, they fly up. They leave the ground after they've found their food. They leave the place where they have come for their nurturing and their nourishment, and then they fly up, they soar.

Moving up, you will begin to discover who you are. So make the decision right now to fly, to change your life by moving up toward God and toward moments filled with yeses and possibilities in life.

Stand Up

Picture yourself as an inflatable boxing toy with a weighted base, a bop bag. Every time you hit that toy, it falls over, but it bounces right back up. Nothing can keep it down unless it's deflated. Refuse to decompress or deflate. When someone punches the breath out of you, inhale. Let God's spirit breathe new hope and life into you. Believe who He says you are, not what others say to defame and degrade you. You are a child of the King, bow to no negative circumstance or critical diatribe, stand up!

Steps to Stand Up

• Believe who God says you are, not what detractors label you.
• Stand up with stand up people; stop sitting down with negative, "ain't it awful" folks.
• Leave the sitting chair of your past behind; decide your future...
• When you get "sick and tired of being sick and tired," don't give up...stand up!

Speak Up

Never let fear keep you from speaking up. God hasn't given you a spirit of fear, but has imbued you with power, love, and a good, sound mind to give voice to your dreams, visions, ideas, and thoughts. So what if you miss the mark with a speech or message? So what if you stumble a bit, mumble, or stutter? Find your voice. Work on your diction. Work on your timing. Work on your voice, presentation, substance, and style. Speak up.

Steps to Speak Up

• Pray and listen to God's leading and direction right now. Ask God to help you to "open your mouth and increase your territory" (prayer of Jabez in 1 Chronicles 4:10).
• Prepare what you are going to say and then practice articulating your message clearly.
• Embrace a bold and courageous attitude.
• Speak up and create an environment and legacy for others to speak up. Start working with those around you.

Look Up

To look up means taking the time to find a place within yourself and around you to renew your spirit. Be intentional. Take a spiritual health break. When all is dark around you and no light shines at the end of your tunnel of despair, look up! Knocked down? Look up. Perplexed and confused? Look up. Surrounded by trouble...and depressed? Look up!

Steps to Look Up

• Set aside a quiet time to pray regularly. Talk with God as you would a friend.
• Get up and walk; don't just sit around bemoaning your problems.
• Ask God for a vision for your life.
• Choose to become new again. Allow God to do a "new thing" in you (Isaiah 43).

Book Up

Reading allows us to continue achieving and growing. I want to know what trials people faced and how they overcame them. How did they rebound when they were knocked down? How do we go from being miserable to fulfilling a mission in life? Grab a few moments each day to read. Go on a trip without ever leaving home. Discover a new world of imagination, reality, and mindsets. Expand your territory: book up!

Steps to Book Up

• Set a time each day to read, even if it's just for five or ten minutes.
• Decide on a business or professional journal or paper to read weekly or even daily.
• Talk with a pastor, teacher, or professional about books they are reading.
• Read Scripture regularly.

Kiss Up

Kissing up is being kind even when the other person slams or persecutes us for no good reason. It's blessing those who really seek to do us wrong or do us in. Blessings are in store for those who choose to be kind, to kiss up, regardless of the attitude or actions of others. Not everyone we kiss up to will someday respond. That's not the issue. Kindness flowers out of who we are, not how others respond!

Steps to Kiss Up

• Don't allow rejection to cause you to give up.
• Remember to plan wisely before you initiate connecting with people.
• Refuse to compromise who you are or your values.
• Take the initiative to connect with those whom you will bless and who will bless you.

Listen Up

Listening up is a valuable gift you give to another person of your time and attention. Don't let others abuse that gift. Set boundaries. Marriage, friendship, or being related isn't a free ticket for abusive dumping. When you need to rest and refresh, turn the phone, beeper, or e-mail off or just don't answer. Go to a quiet, secret place, to commune with God and be renewed. Remember that prayer, a form of listening up, is not just telling God about what you want. It's also listening to God for what He wants; God has wonderful plans for your life if you will just listen up!

Steps to Listen Up

• Keep a pad and pen close by you at all times so that you can listen to God and jot down what He speaks to you.
• Take a sabbatical rest. It may be for a day, or weeks, or months. You may need a vacation in order to get away from the bustle and hear God.
• Take a crisis one step at a time. Listen to God for guidance about each step you should take.
• Be quick to listen, slow to speak, and slow to anger. Speak to hear and understand before you respond.

Hang Up

In Isaiah, God says, "Do not consider the former things nor consider the things of old. Behold I will do a new thing, now it shall spring forth." You are to walk in the newness, which means you must let go of past negatives--ideas, people, and feelings. Setting boundaries, moving on from toxic relationships, deciding to change, and releasing old patterns and bad habits while learning new and constructive ones requires courage, work, and commitment.

Steps to Hang Up

• Hang up when the relationship is controlling, manipulative, intimidating, abusive, or addictive.
• Prepare yourself to hang up by praying, seeking wise counsel, facing the facts, and taking action.
• Set healthy boundaries, refusing to relate to people who tear you down instead of build you up.
• Move up to positive, prosperous healthy relationships after you hang up on the old and embrace God's new for your life.

Make Up

Consider the reciprocity of peacemaking that results from making up: "Blessed are the peacemakers for they shall be called the sons of God." God's blessing comes upon those who live our reconciliation. Make a list of those with whom you need to make up right now. Begin to write, call, e-mail, and visit each one. Forgive. Release. Refuse to take or carry the bait of offense. Jesus said it this way, "Forgive us our trespasses as we forgive those who trespass against us." You've heard it and said it in the Lord's Prayer. Now live it.

Steps to Make Up

• Approach those with whom you are offended and reach out to them with forgiveness.
• Choose to forgive before others repent...even if they don't repent.
• Focus on forgiveness instead of hurt, anger, and offense.
• Pray out loud the Lord's Prayer and speak the Beatitudes.

Wake Up

Waking up to long-term gain may cause you some short-term pain or sacrifice. Scripture reminds us that trial produces patient perseverance, and patience builds character and this process produces hope that doesn't disappoint, outpouring love from God, and power through the Spirit. The process of waking up may be painful, but it does produce character and maturity. Don't give up what's important, wake up to it.

Steps to Wake Up

• Set priorities in line with your life's purpose, not your immediate demands.
• Deepen the close relationships in life, particularly family.
• Take time for what's important; refuse to waste time on draining relationships that have no staying power.
• Be there now and take time with those you will be with throughout life's journey. Begin today.

Cheer Up

Cheer up is about just doing something fun. It's about laughing, doing something that brings joy to your soul. From prison, St. Paul wrote, "Rejoice in the Lord always, and again I say, rejoice!" Find joy for your soul. Everything in life does not have to be hard. A missionary friend in Belgrade often quoted the ubiquitous proverb, "Life is hard and then you die." Life doesn't have to be that way. Cheer up!

Steps to Cheer Up

• Associate with people who cheer you up instead of tear you down.
• Choose to respond with joy; reject the myth that other [people] or things can make you happy.
• Laugh at yourself. Don't be so serious and stodgy.
• Think up ways to cheer up others; by giving cheer you will receive cheer!

Starting Moving Up

Up is a choice, not a command, and it is certainly not something that will just happen. Up takes time, effort, attentiveness, and commitment! Identify people around you who seem to specialize in an up in which you need improvement and growth. Let them mentor or coach you. Hang with them. Ask questions. Imitate them. Develop a hunger and thirst for moving up.

It will be an exciting journey for you. Your engine has already filled up for you. God has just been waiting for you to say you're ready to go up. When you're ready, God's ready. Let's go forward. Get up. Start up!

Barbara: Good Enough is Great

I also appreciated Beyond Blue Barbara's comment on the same post, "12 Ways to Overcome Jealousy and Envy," because it reminded the wisdom in the flick "Babe," when the farmer says to the pig, "That'll do, Pig. That'll do." If only I stopped at that ... when I have done enough, not necessarily an exceptional job, but enough. Barbara writes:

Just a thought, but is there anyone (who isn't driven,) who *always* does their best? From my own perspective, doing my best is never enough to assuage feelings of inadequecy or that old bugaboo of depressives: feeling that if people really knew you, they would see what a phony you are. I have had to learn to see my efforts as *good enough.* Not perfect, or even necessarily my best, but good enough for what is called for.

Feelings of envy and jealousy come from comparing ourselves with others - knowing all our faults and foibles - and none of the person we are using as a yardstick. In that case, we will never measure up. Rather than focusing on the other person, we have to work at seeing ourselves as God sees us: as loveable, flawed children. As we become more able to do that, the need to compare ourselves with others fades. It is something I am working on myself, and is a life-long project. I may not always do my best at it, but I will strive to do it good enough.

The Four Agreements by Don Miguel Ruiz: They Don't Have to Be PerfectThe Four Agreements by Don Miguel Ruiz: They Don't Have to Be Perfect

Thanks to Beyond Blue reader Peg for directing me on the combox to my post "12 Ways to Overcome Jealousy and Envy" to Elizabeth Scott's review of "The Four Agreements" by Don Miguel Ruiz. As I mentioned on other posts, I constantly refer to this book and I was relieved, like Peg, by this summary of his agreements because it was a reminder that you don't have to do them perfectly for them to be effective.

For all of you who haven't yet read "The Four Agreements," the following serves as a great CliffsNotes to this spiritual classic. You can get to Elizabeth's blog on stress management by clicking here.

The First Agreement: Be Impeccable With Your Word

This means avoiding gossip, lies, empty promises and other ways we cause problems with our words. Say only what you mean, and realize that you can cause damage if you're not careful with what you say.

This is a great recommendation. Many people don't realize the power of their words and see the harm that can be caused with speaking carelessly, thoughtlessly or aggressively. Most of us are aware that screaming at someone may be upsetting to them, but subtle little digs at them, or gossip behind their backs, can hurt others more than we realize, and in hurting them, we hurt ourselves. This is an important, but difficult one to follow entirely. It's a great goal to aspire to, though, and a good direction to work toward.

The Second Agreement: Don't Take Anything Personally

This 'agreement' deals with understanding how other people's behaviors are a reflection of them only. When someone gives us feedback about us, it's important to remember that no opinions are truly objective; we all have our biases, 'filters' through which we view the world, and the like. Because of this, we shouldn't take anyone else's view of us or our actions as entirely accurate; when someone says something about us (or anything else), they're really saying something about themselves and how they view the world.

This is good advice for making us feel better, but take it with a grain of salt. While everyone has their biases and there is no such thing as true objectivity, by never taking anything personally, people can really limit their ability to see their own negative patterns and biased thinking, and work on developing more healthy patterns and clear-sighted thinking. As M. Scott Peck says in The Road Less Traveled, "the problem of distinguishing what we are and what we are not responsible for in this life is one of the greatest problems of human existence." Don't give up on the work of distinguishing responsibility, or you end up creating more stress in the long run.

The Third Agreement: Don't Make Assumptions

Much stress is created when people assume they know what other people are thinking without checking with them. Understanding that other people might have different motivations for their actions, even drastically varying world views, and remembering to really try to understand others and discuss these motivations before jumping to conclusions about their behavior, can go a long way toward preventing interpersonal conflict.

However, taking this advice to an extreme may cause people to ignore their intuition about people, or common sense about someone's behavior that's damaging. It can also open people up to manipulation if they train themselves to believe someone's explanation of negative behavior rather than judging the behavior on its own. (For example, not 'assuming' they're being cheated on if their spouse is exhibiting erratic behavior and the classic signs of infidelity, but vehemently denies wrongdoing.) This one is a good suggestion, but should be tempered by inner wisdom and common sense.

The Fourth Agreement: Always Do Your Best

By this, Ruiz means to do the best you can at any given moment, and you'll have no regrets. Some days, your best isn't as good as other days, and that's okay. As long as you put an honest effort into life, you will have nothing to be ashamed of, and will not 'beat yourself up' over a less-than-stellar performance in retrospect.
I think this is good advice for anyone, and see no down-side to it. This behavior can help people acheive more progress toward their goals, and prevent unecessary feelings of regret.

While sometimes the 'agreements' are oversimplified, in my opinion, this is still a great little book with some heavy ideas. If followed generally (and not fanatically), these suggestions can help you reduce a great amount of stress by helping people avoid thought and behavior patterns that create frustration, blame, hurt feelings and other negative emotions.

Bipolar II Meets Bipolar I (and all hell breaks loose): One Woman's Trip to the Dark Side and Back

Thanks to Lilit Marcus for finding this fascinating article about a bipolar woman (Bipolar II) who married a Bipolar I guy. The article's author, Y. Euny Hong, articulates all the drama of the relationship in such incisive language that the bipolar person is sure to wince at similar situations, feelings and thought traps in his/her own life. At least I did, especially with her descriptions of what mania can look like and how it's exhilaration can disguise it as romance, when, in essence, it's the other side of depression.

I've excerpted some paragraphs below, but I urge you to read the full story by www.marieclaire.com/life/sex/advice/manic-depressive-suicidal-spouse

Between January and May of 2006, my husband, Leopold, attempted suicide four times, at nearly regular intervals of five weeks. In June, he disappeared for a month. When he re-emerged, he announced he was quitting me, his job, and the city in which we lived. He was going to teach at a high school in Appalachia.

Just two years prior, we'd met at a mutual friend's birthday party and secluded ourselves on the fire escape, smoking. I lived in New York; he was in D.C. The following Saturday, we talked on the phone for six hours. I visited him two weeks later. Over the weekend, he asked me to move in with him; by Sunday night, we'd picked out the names of our unborn children. Like Tristan and Isolde, we were bewitched by each other. Leopold proposed to me four weeks after that.

My friends thought it was impetuous of me to go along with this breakneck courtship -- especially since the ink was barely dry on my divorce from my first husband -- but I could not be dissuaded. This was my lifelong image of what love should be like, and I was eager to start afresh.

Only later, after meeting with Leopold's shrinks, did I understand that this wasn't romance -- it was a disease. Specifically, it was a symptom of the manic side of "manic-depressive illness," also known as bipolar disorder.

Like many bipolar sufferers, Leopold had gone his whole life without being diagnosed. The mania was seen as part of his personality. He was a consummate romantic, showering me with flowers and surprises. We loved each other to excess. He would say he missed me if we were in two separate rooms of the apartment.

Where I should have seen signs of a problem, I saw lovable quirks. Leopold was able to envision the distant future (like knowing what those unborn children would major in at college). But the short-term future -- anything more than a few months in advance -- eluded him. He had written the first 50 pages of a novel seven years earlier -- but he'd bristle if I pressed him about finishing it.

I attributed tendencies like these to a combination of Gen-X apathy and traditional male immaturity. He once told me, "I'm the best damn writer in the world." But he was unable to take concrete steps to test his abilities. (I later learned that hyperconfidence is also a sign of mania.)

What he couldn't plan for tomorrow, Leopold had no trouble determining for today: Shortly after our wedding, he decided to buy a car. His parents offered him advice on finding the best deal, negotiating the financing rate, shopping around. Leopold left for the dealership at 2 p.m. At 5 p.m. he drove home with a new car. His parents gave him a tongue-lashing for his impulsiveness. He flopped on the bed and told me, "I want to hurt myself."

All honeymoons end; in our case, it ended almost before it began. We often fought about his job, which required him to spend half his time in a Middle Eastern country that was on the State Department's unsafe list. He said, "Everything in my life has been leading up to this job. If you deny me this, you deny me everything." I didn't know how to respond to that kind of extreme, unchecked zeal.

The funny thing is, for most of the time we were together, it was my mental health with which we were preoccupied, not his. Full disclosure: I am bipolar, too. I was diagnosed with bipolar type II years ago. In type II, the manic and depressive episodes are distinct from each other and relatively easy to recognize. It was strangely fortunate that my depression was so pronounced -- I cried constantly, had an irrational social phobia, and didn't brush my hair for months at a time -- because it allowed me to seek help at an early stage.

Leopold, meanwhile, was bipolar type I. His manic episodes were much more pronounced than the depressive ones. Many bipolar sufferers don't seek treatment because the manic side, which in mild stages resembles euphoria, is actually enjoyable. But euphoria can be terribly dangerous. Bipolar people are two to three times more likely to attempt suicide than those suffering from regular depression. They are also, say studies, more likely to complete their attempts.

How Is Depression Different From Sadness?

On Fridays I will address a question related to depression and find the answer from an expert. If you have a question you want answered, please ask it on the combox of this post, and I'll try my best to do some research and feature it in an upcoming Friday post.

One of the most common questions I hear is: How is depression different from sadness?

This question was recently addressed by Ronald Pies, M.D., a professor of psychiatry at Tufts and SUNY Upstate Medical Center in Syracuse, in an opinion piece published in the New York Times. You can get to the original article by clicking here. I have excerpted it below as the answer to this Friday's question. Thanks to Jennifer of NYJLM blog for sending it to me.

Ronald Pies, M.D.: Let's say a patient walks into my office and says he's been feeling down for the past three weeks. A month ago, his fiancée left him for another man, and he feels there's no point in going on. He has not been sleeping well, his appetite is poor and he has lost interest in nearly all of his usual activities.

Should I give him a diagnosis of clinical depression? Or is my patient merely experiencing what the 14th-century monk Thomas à Kempis called "the proper sorrows of the soul"? The answer is more complicated than some critics of psychiatric diagnosis think.

To these critics, psychiatry has medicalized normal sadness by failing to consider the social and emotional context in which people develop low mood -- for example, after losing a job or experiencing the breakup of an important relationship. This diagnostic failure, the argument goes, has created a bogus epidemic of increasing depression.

In their recent book "The Loss of Sadness" (Oxford, 2007), Allan V. Horwitz and Jerome C. Wakefield assert that for thousands of years, symptoms of sadness that were "with cause" were separated from those that were "without cause." Only the latter were viewed as mental disorders.

With the advent of modern diagnostic criteria, these authors argue, doctors were directed to ignore the context of the patient's complaints and focus only on symptoms -- poor appetite, insomnia, low energy, hopelessness and so on. The current criteria for major depression, they say, largely fail to distinguish between "abnormal" reactions caused by "internal dysfunction" and "normal sadness" brought on by external circumstances. And they blame vested interests -- doctors, researchers, pharmaceutical companies -- for fostering this bloated concept of depression.

But while this increasingly popular thesis contains a kernel of truth, it conceals a bushel basket of conceptual and scientific problems.

For one thing, if modern diagnostic criteria were converting mere sadness into clinical depression, we would expect the number of new cases of depression to be skyrocketing compared with rates in a period like the 1950s to the 1970s. But several new studies in the United States and Canada find that the incidence of serious depression has held relatively steady in recent decades.

Second, it may seem easy to determine that someone with depressive complaints is reacting to a loss that touched off the depression. Experienced clinicians know this is rarely the case.

Most of us can point to recent losses and disappointments in our lives, but it is not always clear that they are causally related to our becoming depressed. For example, a patient who had a stroke a month ago may appear tearful, lethargic and depressed. To critics, the so-called depression is just "normal sadness" in reaction to a terrible psychological blow. But strokes are also known to disrupt chemical pathways in the brain that directly affect mood.

What is the "real" trigger for this patient's depression? Perhaps it is a combination of psychological and neurological factors. In short, the notion of "reacting" to adverse life events is complex and problematic.

Third, and perhaps most troubling, is the implication that a recent major loss makes it more likely that the person's depressive symptoms will follow a benign and limited course, and therefore do not need medical treatment. This has never been demonstrated, to my knowledge, in any well-designed studies. And what has been demonstrated, in a study by Dr. Sidney Zisook, is that antidepressants may help patients with major depressive symptoms occurring just after the death of a loved one.

Yes, most psychiatrists would concede that in the space of a brief "managed care" appointment, it's very hard to understand much about the context of the patient's depressive complaints. And yes, under such conditions, some doctors are tempted to write that prescription for Prozac or Zoloft and move on to the next patient.

But the vexing issue of when bereavement or sadness becomes a disorder, and how it should be treated, requires much more study. Most psychiatrists believe that undertreatment of severe depression is a more pressing problem than overtreatment of "normal sadness." Until solid research persuades me otherwise, I will most likely see people like my jilted patient as clinically depressed, not just "normally sad" -- and I will provide him with whatever psychiatric treatment he needs to feel better.

Recognizing Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is marked by recurrent, repetitive thoughts (obsessions), behaviors (compulsions), or both that a person recognizes as unreasonable, unnecessary, or foolish yet are intrusive and cannot be resisted. People with obsessive-compulsive disorder do not necessarily have both obsessions and compulsions, but either one often interferes with day-to-day activities and relationships with others.

Obsessions are recurring and persistent thoughts, ideas, images, or impulses, sometimes of an aggressive or violent nature, that seem to invade a person's consciousness. The sufferer will try to suppress or ignore these uncomfortable thoughts and often recognizes that they are unrealistic. Compulsions are ritualistic, repetitive, and purposeful behaviors that are performed according to certain rules or stereotypical patterns. The behavior, while clearly excessive, temporarily relieves the tension and discomfort brought on by the obsessive thinking.

It is estimated that about 2% of the population suffer from obsessive-compulsive disorder, making it the fourth most common anxiety disorder (after phobias, generalized anxiety disorder, and post-traumatic stress disorder). Obsessive-compulsive disorder most often starts in the teens or the early 20s. Embarrassed and upset by their behavior, most sufferers try to keep their obsessive-compulsive disorder secret; they often function with only minimal interference with daily activities. But obsessive thoughts or compulsive behaviors may be frequent or distressing enough to become incapacitating.

Symptoms of Obsessive-Compulsive Disorder

People with obsessive-compulsive disorder experience recurrent, disturbing thoughts, which can lead to bizarre, ritualized behaviors in an effort to alleviate the anxiety caused by the obsession. For example, an overwhelming fear of contamination may cause people with obsessive-compulsive disorder to excessively wash their hands or shower. Obsessive-compulsive disorder sufferers may spend several hours a day dwelling on obsessive thoughts and performing compulsive rituals. In most--but not all--cases of obsessive-compulsive disorder, obsessions and compulsions occur together.

Unlike those with many other psychiatric conditions, patients with obsessive-compulsive disorder are often aware that their thoughts and actions are irrational, but they cannot control them. Most individuals with obsessive-compulsive disorder try to hide their symptoms from family and friends and are too embarrassed to seek help.
Outlined below are the most common obsessions and compulsive behaviors. While someone without obsessive-compulsive disorder may exhibit one of these obsessions or compulsions in moderation, a person with obsessive-compulsive disorder has symptoms that significantly interfere with daily life.

Obsessions Common to People Who Suffer From Obsessive-Compulsive Disorder:

* Fear of contamination, such as from dirt, germs, or disease

* Fear of harming oneself or others
* Overwhelming concern with order and neatness
* Fear of making a mistake, such as losing something valuable
* Constantly thinking about a certain sound, number, word, or image
* Fear of embarrassing oneself socially, either by saying the wrong thing or making sexual advances

Compulsive Behaviors Common to People Who Suffer From Obsessive-Compulsive Disorder:

* Hand washing, showering, or cleaning oneself repeatedly
* Checking and rechecking to see if doors are locked or appliances are turned off
* Counting to a certain number over and over again
* Repeating words or actions, such as touching a particular object numerous times a day
* Arranging items in a specific order
* Collecting and hoarding newspapers, items, or mail that is no longer needed
* Probably the most common complication of obsessive-compulsive disorder is depression; other complications include alcoholism, abuse of sleeping pills or tranquilizers, and marked interference with normal social and occupational behaviors.

Although some people with obsessive-compulsive disorder experience spontaneous remission, in most, the illness has an episodic course with periods of partial remission. In about 10% of sufferers, the course of obsessive-compulsive disorder is chronic and unchanged. But many effective treatments--including behavior therapy and the antidepressants Prozac (fluoxetine), Celexa (fluvoxamine, citalopram), Paxil (paroxetine), Zoloft (sertraline), and Anafranil (clomipramine)--are now available to alleviate the symptoms of obsessive-compulsive disorder.

The Path to Joy

10 Principles of Spiritual Optimism

In his newest book, "Why is God Laughing?" renowned teacher Deepak Chopra gives a humorous take on spirituality--using a fictional tale of a comedian and his unlikely mentor to show the way back to hope, joy, and even enlightenment. Here are 10 principles for spiritual optimism adapted from the fable that will help you direct your life on a path to joy every single day.

The Healthiest Response to Life Is Laughter.

This first principle serves as an antidote to fear and sorrow by encouraging you to experience life as joyous....When you feel momentary happiness, or you want to burst out laughing, or you smile for no apparent reason, you are glimpsing eternal reality....In time, these moments of joy will begin to knit together. Instead of the exception, they will become the norm. There is no better way to know that you are growing in God-realization.

There Is Always a Reason to Be Grateful.

This second principle is an antidote to victimization....The purpose of gratitude is to connect yourself to a higher vision of life....Once you realize that you alone are the projector of reality, you will no longer be dominated by external events. You will correct the mistake that lies at the very root of victimization: a belief that the movie controls you, instead of the other way around.

You Belong in the Scheme of the Universe. There's Nothing to Be Afraid Of. You Are Safe.

The third principle is the antidote for insecurity....The role assigned to you is right and proper. It is tailor-made for you, for your complete self....The voice of fear tries to convince you that you are a helpless victim of chance. The very opposite is true. At the deepest level, the level of the soul, you are the author of everything that happens to you.

Your Soul Cherishes Every Aspect of Your Life.

The fourth principle is the antidote for feeling undervalued. It states that your worth is absolute, and that everything that happens to you - whether it feels good at the time or not - is part of a divine plan unfolding from the level of the soul....A person's worth is the value of a soul, which is infinite. Since every event in your life isn't happening just to a person but to a soul, everything in life should be cherished.

There Is a Plan, and Your Soul Knows What It Is.

The fifth principle is the antidote to meaninglessness. It states that your life has a purpose. You determine that purpose at the soul level, and then that purpose unfolds in daily life as part of the divine plan. The more deeply you are connected to the plan, the more powerful it becomes in your life. Ultimately, nothing can stop it.

Ecstasy Is the Energy of Spirit. When Life Flows, Energy Is Natural.

The sixth principle is the antidote to inertia. It states that infinite energy is available to you. You are a co-creator with God. To claim your creative power, you need only connect with the primal energies that play within you....The kind of energy you can call upon at any given moment depends on your level of consciousness.

There Is a Creative Solution to Every Problem. Every Possibility Holds the Promise of Abundance.

The seventh principle is the antidote to failure. It tells us that every question includes its own answer. The only reason a problem arises before its solution is that our minds are limited - we think in terms of sequences, of before and after. Outside the narrow boundaries of time, problems and solutions arise at the same instant.

Obstacles are Opportunities in Disguise.

The eighth principle is the antidote to inflexibility....The secret is to abandon old habits and trust in spontaneity....Whenever you catch yourself reacting in an old, familiar way, simply stop. Don't invent a new reaction; don't fall back on the opposite of what you usually do. Instead, ask for openness. Go inside, be with yourself, and allow the next reaction to come of its own accord.

Evolution Leads the Way Through Desire.

The ninth principle is the antidote to hypocrisy. It encourages us to act on our genuine desires, because they show the way to real growth. Don't pretend to be better - or other - than you are. Don't fall into the trap of having one face for the world and another to God. Who you really are is exactly who you should be.

Freedom Is Letting Go.

The tenth principle is the antidote to attachment....If you let go of what isn't real in your life, what's left will be real: what's left is God alone....To be free, you must find a way to let go of all the stuck energy that keeps sending the same old messages....The past is a false guide to the future, and yet it's what most of us rely upon. By letting go of stuck energies, you let go of your past.