Author Archives: Susan

New APA Guidelines Spark Debate, Criticism

The American Psychological Association has triggered debate with its Guidelines for Psychological Practice with Boys and Men, published in August 2018 and followed with an essay posted on the APA website CE Corner in January, with a statement that “… traditional masculinity is psychologically harmful …,” by Stephanie Pappas.

According to the authors, the Guidelines provide “general recommendations for psychologists who seek to increase their awareness, knowledge, and skills in psychological practice with boys and men.” Other beneficiaries of the guidelines include all consumers of psychological practice including clients, students, other health professionals, institutions and agencies, write the authors.

The Guidelines are authored by Fredric Rabinowitz, Matt Englar-Carlson, Ryon McDermott, Christopher Liang, and Matthew Kridel, with assistance from Christopher Kilmartin, Ronald Levant, Mark Kiselica, Nathan Booth, Nicholas Borgogna, and April Berry.

“Masculinity ideology is a set of descriptive, prescriptive, and proscriptive of cognitions about boys and men,” write the authors.

“Although there are differences in masculinity ideologies, there is a particular constellation of standards that have held sway over large segments of the population, including: antifemininity, achievement, eschewal of the appearance of weakness, and adventure, risk, and violence. These have been collectively referred to as traditional masculinity ideology (Levant & Richmond, 2007).”

“The present document articulates guidelines that enhance gender- and culture sensitive psychological practice with boys and men from diverse backgrounds in the United States,” write the authors.

For its definition section the Guidelines cover topics of gender, cisgender, gender bias, gender role strain, masculinity ideology, gender role conflict, oppression, privilege, psychological practice, and gendersensitive.

In the 30 plus page document, available at APA, the 10 Guidelines are: 1) Psychologists strive to recognize that masculinities are constructed based on social, cultural, and contextual norms; 2) Psychologists strive to recognize that boys and men integrate multiple aspects to their social identities across the lifespan; 3) Psychologists understand the impact of power, privilege, and sexism on the development of boys and men and on their relationships with others.

And, 4) Psychologists strive to develop
a comprehensive understanding
of the factors that influence the interpersonal relationships of boys and men; 5) Psychologists strive to encourage positive father involvement and healthy family relationships; 6) Psychologists strive to support educational efforts that are responsive to the needs of boys and men; 7) Psychologists strive to reduce
the high rates of problems boys and men face and act out in their lives such as aggression, violence, substance abuse, and suicide.

And also, 8) Psychologists strive to help boys and men engage in health-related behaviors; 9) Psychologists strive to build and promote gender-sensitive psychological services; 10) Psychologists understand and strive to change institutional, cultural, and systemic problems that affect boys and men through advocacy, prevention, and education.

Dr. Edward Adams, past president of Division 51 on Men and Masculinities of the American Psychological Association, defended the guidelines as supporting cooperation, respect, appreciation, and courage.

Dr. John Grohol, founder of the popular PsychCentral published a review of the guidelines with a neutral, positive, and brief explanation of the meanings.

Primary author, Fredric Rabinowitz, Professor of Psychology at University of Redlands, links to two January media articles, “Traditional Masculinity Can Hurt Boys, Say New A.P.A. Guidelines,” a The New York Times, and “Traditional masculinity’ labeled ‘harmful’by major psychologist organization,” reported by public radio in Southern California.

However, the guidelines and essay attracted criticism from various groups. In a January article in National Review, “Grown Men Are the Solution, Not the Problem,” David French wrote “We are in the middle of an intense culture war focused around men.”

In another report, Steven Pinker, a professor of psychology at Harvard, criticized the Guidelines saying that the authors reject biological and genetic factors, and also embrace a folk myth that expressing negative emotions is better than restraining them with selfcontrol.

Andrew Sullivan, in a critique in the New York Intelligencer, titled “The Pathologized Male,” noted “It felt demeaning to read. To tell you the truth, it reminded me of the way psychologists used to treat gay men: as pathological, dangerous, and in need of reparative and conversion therapy.” And he wrote, “If this document were designed to encourage men to seek psychotherapy, it is a catastrophe.”

Similar comments appeared across the web. “We should be able to celebrate masculinity and its positive attributes while making it clear that there are behaviors that are unacceptable, without insulting and demonizing men.” And another said, ” I don’t think we should be shaming anyone for who they are.”

On January 14, APA tried some damage control with, “A Closer Look at the APA Guidelines for Psychological Practice with Boys and Men,” with a section on “Embracing Masculinity.”

“Psychologists who treat men and boys already know that their male clients aren’t stereotypes. They have feelings, needs and desires. They’re adaptable. They possess many positive masculine characteristics. The guidelines are designed to give psychologists a framework to help men and boys embrace their masculinity in ways that are helpful, rather than harmful, to their health and quality of life.”

APA “In the News” links to an article “How ‘Traditional Masculinity’ Hurts Those Men Who Believe in it the Most,” by a Washington Post columnist.

And APA gives the headline, “Many people responded as if APA’s guidelines were an indictment not of rigid, traditional masculinity but of all masculinity, and of men themselves.”

The essay by Pappas appears to be removed from the January APA news, and in CE Corner the learning objective about traditional masculinity being harmful has been noted to be edited for clarity from the original version.

CDC Year End Report: Mortality Rates Higher in Most Causes of US Deaths

A year end CDC analysis of data reveals that life expectancy for Americans continues to decline. Despite U.S. health costs being the highest around the world, mortality rates increased for 7 of the 10 leading causes of death in the U.S. reported the CDC in a review for 2018.

Drug overdoses continued to increase – 47,600 drug overdose deaths involved any type of opioid, including heroin and illicit opioids, representing over two-thirds of all overdose deaths. U.S. overdose death rates linked to synthetic opioids, likely from illicitly manufactured fentanyl (IMF), increased more than 45 percent from 2016 to 2017 while death rates from heroin and prescription opioids remained stable and high.

CDC said suicide rate among the U.S. working-age population increased 34 percent between 2000 and 2016. Additionally, suicide rates rose in nearly every state between 1999 and 2016. Suicide is the 10th leading cause of death and its rise has contributed to lowered life expectancy.

CDC released data showing a steep and sustained increase in sexually transmitted diseases (STDs), including nearly 2.3 million cases of chlamydia, gonorrhea, and syphilis.

New cases of STDs surpassed the previous record by more than 200,000 cases and marked the fourth consecutive year of sharp increases in these STDs.

Chronic disease continues to remain a priority, said the report. Heart attacks, strokes, heart failure and other related conditions caused 2.2 million hospitalizations, resulting in $32.7 billion in costs and 415,000 deaths, according to CDC.

Officials noted these health problems are largely preventable. Many of these events were in adults ages 35-64.

According to the latest data for Louisiana, 2014, the leading causes of death were heart disease, then cancer, accidents, respiratory disease, stroke, and Alzheimer’s disease. Louisiana ranks 5th, 4th, 12th, 23rd, 4th and 6th respectively in the nation for these causes of death.

Pennington’s Dr. Tiffany Stewart in Spotlight for Innovative Health Programs

Clinical Psychologist and Pennington Biomedical research scientist, Dr.  Tiffany Stewart, is applying her innovations for a community health program at the Knock Knock Children’s Museum, located at 1900 Dalyrmple Drive, Baton Rouge.

The program is a collaborative effort between the Baton Rouge Mayor’s Healthy BR Initiative, the Museum, Pennington, and other community organizations, noted a release in January.

Dr. Stewart, who directs the Pennington Biomedical Behavior Technology Laboratory, and her team will provide the program called “Sisu & You: Healthy Kids and Healthy Family Workshop.” Sisu is the Finnish word for resilience.

The workshop will be held on the fourth Thursday of each month through May and is free for children ages five to 15.

Parents are encouraged to join their children in “connecting ideas with actions for a lifetime of health and happiness.”

“How we view our bodies is a key component of successful health behaviors and significantly affects our quality of life,” said the developers. “This workshop series teaches children and adults to keep their bodies healthy through nutrition, fitness, sleep, and body image.”

The Behavior Technology Laboratory at Pennington is dedicated to Translational Research: Dr. Stewart and her team focus on taking health behavior change programs and technologies from the workbench of science and craft them into programs everyone and anyone can use.

She and her team investigate the novel assessment, prevention, and intervention approaches for eating disorders, obesity, and body image disturbance on health behaviors and chronic disease outcomes.

Dr. Stewart’s work has attracted multimillion dollar funding from the National Institutes of Health and the Department of Defense. She develops programs and technologies to improve nutrition, fitness, and sleep of U.S. Army Soldiers and their family members.

Recently her work with the US Army was showcased in an article by Stephanie Riegel for the Baton Rouge Business Report.

Stewart’s Healthy Eating, Activity, and Lifestyle Training Headquarters or H.E.A.L.T.H., is part of the Weight Measurements and Standards for Soldiers Project.

H.E.A.L.T.H. is an ongoing, fifteen-year collaborative effort between Pennington and the Department of Defense, designed to aid Soldiers in maintaining healthy weight status, fitness status, combat readiness, and Warfighter performance.

H.E.A.L.T.H. includes programs to aid soldiers’ family members in reaching overall health and fitness goals and incorporates cutting edge interactive technology such as with the Internet and Smartphones, so soldiers and their family members can use it wherever they are in the world.

H.E.A.L.T.H. is considered a population health program, used and tested in two pilot projects, at Ft. Bragg, NC, and New England Reserves, and is being tested in the Louisiana Army National Guard.

The program is currently being disseminated Army-wide as part of the U.S. Army Surgeon General’s Performance Triad Initiative to improve nutrition, fitness, sleep, overall health, and resilience for our technologically advanced fighting force and their families. Approximately 15,000 individuals have used the H.E.A.L.T.H. program.

Stewart explained, “The mission of the H.E.A.L.T.H. program is to translate evidenced–based concepts into a nutrition and fitness tool that Soldiers can use to not only improve Warfighter health and performance, but the overall health well-being of their family members.”

Another of Stewart’s programs has been to improve body image, nutrition, and eating disorders in female collegiate athletes. “Female Athlete Body Project: A Randomized Controlled Trial”, is a partnership with Louisiana State University Athletics, American University in Washington, D.C., and Trinity University in San Antonio, TX.

Research suggests that disordered eating among female athletes is prevalent, and is especially dangerous in female athletes because it increases risk for the Female Athlete Triad (i.e., low energy availability/disordered eating, menstrual disorders, and decreased bone mineral density/ osteoporosis and subsequent injury).

Research supports the use of a program targeting small lifestyle modifications in the prevention of ED onset and in reducing ED and obesity risk factors.

Dr. Stewart is also an inventor and entrepreneur, and named 2015 Woman of Excellence by the Louisiana Legislative Women’s Caucus Foundation. She was also commended by the Louisiana Legislature in a House Concurrent Resolution for her work and research, and for “spearheading unique, large, multi-site prevention studies that have included the development and deployment of novel approaches for health behavior change, …”.

In the private sector, Stewart is Founder and Chief Scientific Officer of Body Evolution Technologies Inc., a venture capital-funded entrepreneurial project dedicated to taking e-health assessment, prevention, and treatment programs and technologies from the lab to those who would benefit most, “… especially among young women as they face enormous pressures concerning body-image, weight, eating behavior, and selfesteem.”

Body Evolution Technologies was designed to commercialize evidencebased health behavior technology and is an entrepreneurial venture, formed as a result of scientific discovery at Pennington, and funded by angel and venture capital investors. The programs and assessment tools are integrated within a social network environment to reinforce learning and promote adherence. See programs at http://www.emergebodyimage.com/, an e-health, online platform.

 

Cold Pursuit: A Review

by Alvin G. Burstein

This movie begins with an Oscar Wilde epigram: “Some cause happiness wherever they go, others whenever they go.” That sets the tone for this movie, both in substance and in style. It is a movie centered on murderous revenge—a death that brings happiness to an avenger. And Wildean ironic humor is reflected in the film’s slyly funny moments. A hoodlum breakfasting on Fruit Loops while his child companion is downing a green drink. Wry exchanges between two cops about the degree of criminality in smoking pot. The film’s arch sociopath’s tantrum when a kidnapper fails to follow underworld rules about how to behave.

The movie is about killing for revenge, and many viewers will regard it as a splatter film because of its gross out graphic detail. But there is more to it than the gore and the comic counterpoint. Some literary critics talk about “inter-textuality,” the notion that every story one is told (or tells) is shaped and illuminated by the other stories known to the writer and to his or her audience. Cold Pursuit resonates strongly with the American classic Moby Dick. In Herman Melville’s whaling saga, Captain Ahab is a monomaniac. His rage driven thirst to kill the whale responsible for Ahab’s losing his leg has emptied his life of any other purpose or capacity for pleasure. As he puts it, “I am demoniac, madness maddened!…The path to my fixed purpose is laid with iron rails on which my soul is grooved to run.” The compulsion leads to the destruction of Ahab, his ship and his crew, all save one, a point of correspondence to which I will return.

The protagonist in Cold Pursuit is Nels Neelson, a taciturn snow plow driver who battles the persistent onslaught of snow in his ski resort town. We meet him, a distant tiny figure driving his plow against an overwhelming canvas of white snow. We see him, a taciturn man, awarded the Citizen of the Year award for his unstinting efforts to keep roads open, reluctantly stumbling through an acceptance speech and learning that his son has died, killed by an overdose of heroine. Nels knows that his son was not a user, and begins a search for those responsible for his son’s death. He becomes a vigilante, working his way up the ladder of informants toward the drug cartel’s sociopathic leader, Viking, leaving dead bodies on every step.

Viking attributes the death of his underlings to a rival cartel of American Indians. He kidnaps and kills the only son of the rival cartel’s chief, White Bull, sending the slain man’s head to his father. Maddened, like Ahab, by his loss, White Bull swears he will be revenged, “…a son for a son…”. He must kill Viking’s only son.

Unaware of the eruption of inter-cartel war and its consequences, Nels decides the best way for him to lure Viking into the open is for him to kidnap Viking’s pre-teen son. He does so, and an unexpected Stockholm syndrome bond develops between the boy and his kidnapper. A gotterdamerung scene explodes with both cartel gangs converging on Nels’ hideout, where Nels has persuaded the boy to stay concealed out of harm’s way. Everyone else, including Viking, is killed except for Nels and White Bull, who leave together in Nels’ huge snow plow before the police arrive. Nels takes his  passenger to the head of the towering water fall above the village. When he opens the last barrier to the closed road, he answers White Bull’s query about what he was up to by saying “It’s what I do.” Some may take that as a reference to clearing roads. I take it to be a reference to his new career, killing. He and White Bull, like Ahab, have acquired lives whose only meaning is seeking revenge. With Viking dead, and without their sons, the two have nothing to live for.

When the police arrive at the body strewn scene of the final conflict, they find Viking’s orphaned son. In Moby Dick, after Ahab and his ship have sunk, a companion ship arrives to look for survivors, only to find “another orphan,” the sole survivor who tells the story.

Stress Solutions

by Susan Andrews, PhD

Stress vs Anxiety: Can You Tell the Difference

Is there any difference between stress and anxiety? Of course, there is, but there are probably more similarities than differences. Some of the common symptoms between stress and anxiety include: sleepless nights and subsequent exhaustion, excessive worry, difficulty with focus, irritability, muscle tension, rapid heart rate, and headaches.

The differences between anxiety and stress are important. Stress is your body’s immediate reaction to a problem or coming event, or some sort of trigger. The trigger can be positive or negative. And, the stress reaction is normally short-term. Stress is normal for everyone. No one can live a completely stress-free life. But, usually when something triggers the stress
reaction, our body automatically reverses the physical reactions once the trigger is gone. For instance, when you have a deadline to complete an activity or a job, stress kicks in and actually can help you meet your deadline. That’s a good thing.

Anxiety, on the other hand, is not usually “short-term.” That is, when anxiety becomes a sustained problem, it then becomes a mental health problem. An alarming fact is that Anxiety Disorders are the most common mental health disorder in the United States, affecting 40 million adults and uncounted numbers of our children. This is at least 18 to 20% of the population.

The odd interaction or blending of the boundaries of these two similar mechanisms we use to deal with life is that stress can cause anxiety and anxiety definitely triggers stress. Anxiety causes stress because the excessive worry and constant thinking automatically triggers Cortisol, among other bodily stress reactions. That leads to being unable to rest or sleep, problems with focus and so on. In other words, stress and anxiety often go hand-n-hand.

In dealing with either or both, however, it all comes down to Thinking. What we think. How much we think. Whether or not we can let go of a negative thought or worry. Whether or not we can clear our mind of thoughts, positive or negative, to fall asleep or to rest for a few minutes. When we become unable to control our minds and what and how long we think, the inevitable result is a high degree of stress and anxiety that can cause all the negative consequences one can read about.

So, learning how to stop thinking, clear your mind, change the inner dialogue topic are the primary keys. How do we do that? Most people can recite a list now. However, reciting a list and actually doing some of the things on the list are two different things. The list includes: Breathing and relaxation techniques, Mindfulness, Meditation, Exercise, Changing what you are doing – like, taking a break in the activity that might be producing the stress and doing something else, and Music – either listening or if you are one of the lucky ones who learned how to play an instrument – playing music has amazing benefits for mental and physical health. As a group of mental health practitioners, we need to teach children how to control their thinking and how to clear their mind and relax. Children who grow up with those abilities will live longer, be more productive and live life with more joy. It’s never too late.

On The Basis of Sex

by Alvin G. Burstein

This biopic focuses on an early case argued by Ruth Bader Ginsburg, now in her twenty-sixth year on the Supreme Court, the second female justice to be appointed. The screenwriter, Daniel Stiepleman, is her nephew, and  unsurprisingly, the film is a warm tribute to someone who has become an icon of political liberalism in general, and of women’s rights in particular. All biopics are entertainment products, and complexity is sacrificed to achieve an emotional effect; On the Basis of Sex is an impressive feel-good film documenting an instant in the long and continuing struggle for women to be seen as fully human, more than chattel.

The film begins with Ginsburg’s matriculation into Harvard’s law school, one of the nine women in a class of about 500 to be enrolled in that year. We learn that she is married, that her husband has also enrolled, that they have an infant child. At a welcoming dinner the Dean asks the women what justifies their taking the place of a male student. He cannot not know, and the film does not take note of, how that question might resonate with Ginsburg’s failure to qualify for the minyan—the mourners who count—at the Jewish funeral of her father, who died when she was in her late teens. The film does not describe the process by which Ginsburg, who learned Hebrew as a child and served as a “junior rabbi” at summer camp, became non-observant. Nor does the film have space to tell us of her comments at a 1993 meeting of Harvard alumnae. There, Ginsburg described her failure to get a position at any New York City law firm after completing her clerkship, “I was Jewish, a woman, and a mother. The first raised one eyebrow; the second, two; the third made me indubitably inadmissible.” The biopic collapses these complexities into a job interview in which the prospective employer, who after his eyes have focused on Ginsburg’s décolletage, says that adding a woman lawyer to the firm would make wives jealous. We miss an exploration of Ginsburg’s ambivalence about Jewishness and its patriarchal element.

Another ellipsis, a factual one, is with regard to the role of the case central to the film, Moritz v. the Internal Revenue Service. Moritz is an unmarried man who had to hire a nurse to help care for his aged and disabled mother, so he could continue to work. He sought a tax deduction to help defray the cost. The IRS code specified that such deductions were limited to “a woman, widower or divorced, or a husband whose wife is incapacitated or institutionalized.” On that basis, Moritz’s request was denied. Moritz was persuaded to appeal when Ginsburg and her husband, pro bono, agreed to argue the case before the 10th Circuit Court of Appeals. Ginsburg saw this as a uniquely appropriate case to argue against discrimination on the basis of gender because the person discriminated against was a man, though her belief was that women were those most often the objects of gender-based discrimination.

Ginsburg prepared a lengthy brief. Before Moritz was heard, she shared her brief with lawyers arguing another case, Reed v. Reed. In that case a divorced couple in Idaho were both seeking to be appointed to administer the estate of their deceased son. Idaho law stipulated that “males must be preferred to females” when more than one person were qualified to be administrators of an estate. Reed v. Reed went to the Supreme Court before Mortiz was heard in the 10th Court of Appeals. Utilizing Ginsburg’s brief, Ms. Reed’s lawyers persuaded the court that the state law violated the 14th amendment to the constitution’s equal protection guarantee.

The Reed v. Reed decision by the Supreme Court was handed down before Moritz was heard in the Appellate Court, establishing a precedent that the decision for Moritz took further, invalidating myriad federal regulations that  discriminated on the basis of gender. But, to heighten the dramatic tension, and highlight the radical nature of the latter case, Ginsburg is depicted as at first stumbling, but then making an emotional statement that the world
is changing and that the law must reflect the change, winning the case.

A final point. As the movie ends, we see a young Ginsburg walking step by step up the long stairway to the Supreme Court, a metaphor for her long struggle on behalf of women’s rights. As she approaches the building the camera moves to see the women from the front—and it is an older Ginsburg herself. It is an impactful moment. If we had followed Ginsburg herself into her chambers, we would have seen a calligraph hanging on her wall reading, in Hebraic script: “Zedek, Zedek Tirdof.” It is from Deuteronomy—an injunction by Moses, “Justice, Justice You Must Seek.” It is a reminder that justice cannot be codified, must be continually searched for, and also a recognition of Ginsburg’s Jewish roots.

Stress Solutions

by Susan Andrews, PhD

10 Stress-Free Minutes a Day Keeps the Doctor Away

It is true that most of us cannot avoid stress, especially if we want to continue to be an active participant in the world. Stress goes with the territory of juggling a career, a family, and a  social life. Most of us understand only too well the dangers of continuing to schedule full days, of adding new projects to an already overlong list, and still trying to find some time for ourselves at the end of the day. We routinely overbook ourselves. Some of us have the grace to promise to do better next week and might even believe that we can make it up later. But, can we? Chronic stress is now linked to so many problems related to illness, chronic health problems, anxiety, loss of memory, and reduced longevity that it would take the rest of this column to simply list all the ways it affects our lives. We know, for example, that the things we think about and dwell on can have a direct effect on how much cortisol, or stress hormone, is produced in our body. Keeping the cortisol down has become a new goal for the health conscious.

Researchers from the University of California, Davis published findings from a long-term study, called the Shamatha Project, that studied how meditation influences the brain and mental health.  article published in the journal Health Psychology reports that meditation, and particularly mindfulness training, helps lower stress and cortisol levels, which in turn can help you lose excess weight and avoid developing “cortisol belly.”

Manage Your Stress…Not the Other Way Around

It’s time to draw a line in the sand and start reducing stress and cortisol. What I am proposing is not perfect, but it is a start that you can build on. If you keep waiting until you have the time, or until you can do it “right,” it could be too late. Stop letting your calendar manage you. Don’t “try” to do better. As Yoda says, “Do or Do Not!”

Begin Your 10 Stress-Free Minutes Today

You might think that 10 minutes a day is not much help. But it is. A few minutes goes a long way toward recharging your energy and breaking up your resistance to taking breaks. You can gradually add more mental “down time” and physical relaxation to each day. Get started by making yourself push away from your desk or daily routine for 10 minutes. Take this break with the intention of taking a brief mental holiday; give your mind a rest. Why not begin with 10 minutes of Mindfulness? Or, spend 10 minutes in focused breathing (with longer exhale). Add some music or put your feet up, close your eyes and direct your favorite piece of music. Remind yourself to do this daily by putting the reminder into your smart phone.

And, by the way, those of you who work with stressed-out clients, I have found that many  seriously stressed patients are so overwhelmed that they cannot even begin to think about how they can reduce their stress. The above suggestion that they start with just 10 minutes a day has helped many people start adding relief to their day. Once they begin, the time can be gradually increased. Psychology tells us that making a conscious choice with commitment is a powerful tool. Do as I say AND as I do.

Stress Solutions

by Susan Andrews, PhD

New Years’ Resolution: This Year I’ve Got to Manage Stress Better

It’s that special time of the year when we make those statements about our goals for better living for the coming year. I don’t know about you, but every time I make a resolution that resolution that involves diet or exercise or work habits, I tend to forget that I even made such a resolution by mid-March. Life happens, and we adapt and move on. The first thing to go for many people is exercise unless you are one of those people who have been focused on exercise and have made it a full-blown habit. Stress takes a big toll on most professionals who are building a career. Consider making a 2019 Resolution to manage your stress better this year. It will improve your health and your happiness.

Habits are very stubborn things. It is tough to break a habit. But, it is even tougher to build a new habit. A few new books have even been written about how to build good habits and keep them going strong. I recommend The Power of Habit: Why We Do What We Do in Life and Business, by Charles Duhigg (2014). This book was a New York Times Bestseller and available many places.

Developing a habit is like making a decision and then working to make it “automatic” behavior, things you do without planning them first or even thinking about them or making a list. Duhigg asked some great beginning questions in the prologue: What is the first thing you do in the morning? Hop in the shower? Brush your teeth? Grab your cell phone and check your messages? Duhigg’s basic message is that habits can be changed if you understand how they work.

William James wrote in 1892: “All of our life, so far as it has definite form, is but a mass of habits.” Whereas many of our habits get in our way and keep us in a loop, developing strong positive habits can make you more productive and effective at what you want to do.

Pick out one or two ways that you want to try to manage your stress better on a daily basis. We have gone over a large number of them. Don’t try to do too many at once. You are more likely to be successful if you start with one or two relaxation techniques that do not take a huge amount of time and that you think will really work for you. If successful, you can always add more down the line.

The key to building any new habit, even taking frequent relaxation breaks, is to repeat the new behavior frequently so that it can become an established pattern or link in your nervous system. Developing a habit basically means that a behavior becomes more or less automatic for you. Various experts offering advice on how long it takes to build a habit agree that it takes frequent repetition for 14 to 21 days. That means you have to be very aware of and conscious of repeating the same behavior each day multiple times. Any person who has made a New Year’s resolution to lose weight or start an exercise regimen knows that if you miss even a few days in the beginning of trying to start a new habit, you are probably not going to succeed. The old expression “just wait till next year” may come from that. There is no time like the present to start building a new habit of working with stress solutions. So, I leave you with the following message: This is a good time to take a relaxation break.

 

Mary Poppins Returns: Supercalifragilisticexpialidocius?

by Alvin G. Burstein

I viewed the 2018 sequel in the context of two of its predecessors: the 1964 Mary Poppins block-buster film featuring Julie Andrews and Dick Van Dyke and the 1934 book by that name written by P. L. Travers.

Set in 1935, the sequel picks up the story of the Banks family twenty-five years after Mary Poppins departure in the first film. Michael, the oldest son, is now widowed and trying, with the help of his sister, Jane and Ellen, the maid, to raise his two children. Having to raise money that his paltry salary is inadequate to meet, he has taken a loan from his employer, the Fidelity Fiduciary Bank, and has fallen behind in re-paying it. As the movie opens, he and the family learn that the Bank is about to repossess their home and evict them. His son, George, finds his father’s childhood, about to be discarded kite, and takes it to the park. Once airborne, the kite returns—bearing Mary Poppins. She returns to her nanny duties, involving the children in sundry adventures, and ultimately is central in foiling the threatened dispossession of the family.

Both films are froth, fanciful confections. If you liked the first film, you will like the second. But there are some differences. Though real in a cartoonish sense—think chim chim cher-ee and superacalifragilisticexpialidocius. Those of the sequel more mood lifting, like Orphan Annie’s Tomorrow.

Dick Van Dyke, the chalk artist and chimney sweep in the first film, dances with Astaire-like precision; Lin-Manuel Miranda, the lamp-lighter in the sequel, dances with an athleticism that evokes memories of Gene Kelley. Emily Blunt’s Mary Poppins displays a taste for exhibitionism and an attachment to her charges that is less prominent than is Julie Andrew’s. Both films center on an evolution in the character of the fathers in succeeding generations. In the first film, Mr. Banks becomes less business oriented, more playful and familycentered. In the second film, his son, that Mr. Banks, becomes less depressed and more assertive. Changes in both cases, but quite different ones.

Lastly, doubtless as a function of a heightened contemporary concern about such matters, the second film is much more scrupulous in avoiding invidious racial stereotyping. The second film has Black characters in substantial roles; the first has Admiral Boom, upset at the sight of a group of sooty chimney sweeps cavorting, having his cannon fired at them, referring to them as Hottentots.

Both films differ from the Travers book in important ways. Most important is that the movies’ great strength is spectacle, fascinating the audience with an elaborate, intricate, kaleidoscopic firework display. The book, when read, stimulates the imagination. The films distract. The book provokes. The experiences of children reading the book or having it read to them by a parent is vastly different and much richer than that of a child entranced by the film. That is probably true in general of movie watching versus reading. That difference is especially clear in the case of Mary Poppins, who, in Travers book, has a hamadryad in her ancestry and wears a snake skin belt. For readers of any age, that Mary Poppins is darker, more complex, and more compelling than her screen version.

 

Gov. Appoints Mr. Heller To Psychology Board as New Consumer Member

On December 27 the Governor appointed Amitai Heller, of New Orleans, to the Louisiana State Board of Examiners of Psychologists. Heller is an attorney with the Advocacy Center of Louisiana. He will serve as a private citizen and consumer member on the board, a new reform put forward in the 2018 legislative session by Senator Mills.

Mr. Heller works in the legal division of the Advocacy Center, an organization that serves people with disabilities and senior citizens. According to their website, “The Advocacy Center of Louisiana protects, empowers, and advocates for the human and legal rights of people with disabilities and seniors living in Louisiana, in order that they may live an integrated life in the community, free from abuse, neglect and exploitation.”

“The agency was founded pursuant to a federal law establishing protection and advocacy systems in each state and territory in the U.S. The mandate of the protection and advocacy systems is “to pursue legal, administrative, and other appropriate means to ensure the rights of persons with development disabilities in the state.” Since 1977, we have added other populations to our client base including persons with other mental and physical disabilities and senior citizens

Rural Health Focus On Opioid Deaths

The Louisiana Department of Health announced in September 2018 that it had received a Federal grant of more than $24 million toward addressing the opioid epidemic in our state, said Dr. Tiffany Jennings, licensed psychologist in Shreveport, and Louisiana Psychological Association (LPA) Rural Health Coordinator for the American Psychological Association, and chair of the LPA the Rural and TeleHealth Services Committee.

According to the United States Department of Agriculture (USDA) almost 200 people per day died from drug overdose in 2017, more than 72,000 Americans during the year. The overwhelming majority of these overdose deaths involved an opioid. The Centers for Disease Control and Prevention said that the rates of drug overdose deaths are rising in rural areas, surpassing the numbers in urban areas.

“This grant was funded from the Center for Disease Control and Prevention and the US Dept. of Health and Human Services,” said Dr. Jennings. “The money will be used for improving access to treatment, prevention strategies, improving surveillance data and to enable health centers and other agencies to expand integrated services treatment.”

“But we’ve still got a long way to go,” said Jennings. “Mental Health America ranked Louisiana 45th for access to mental health care. In 2016, the Medicaid expansion did provide insurance coverage for more than 430,000 people, it’s difficult to obtain mental health services. Many doctors and agencies will not accept Medicaid due to reimbursement issues and low reimbursement rates. Agencies that do take Medicaid have a waiting list,” she said.

Dr. Jennings has previously served as a neuropsychologist at Overton Brooks Veterans Administration Medical Center in Shreveport and also neuropsychologist for the U.S. Army’s Traumatic Brain Injury Clinic in Fort Polk in Leesville, Louisiana.

As Rural Health Coordinator for APA and LPA, Dr. Jennings has said that one of the goals of her committee is to “develop an ongoing community where those in rural areas, or who serve rural populations, can collaborate with each other.” She said that sharing experiences as to how to set up various telehealth services and also to review current guidelines will be important goals ….”

“Another objective in mind is initiating and continuing the conversation regarding the opioid crisis,” said Dr. Jennings previously. “… it’s a major focus of concern.”

“Telemedicine has been gaining more ground in treatment, particularly for those in rural areas where treatment services may be limited, or non-existent,” she said. “University Health in Shreveport was highlighted in the local media (KTBS.com) highlighting the advantages of telemedicine –such as cost, reduced transportation burden–and that telemedicine can be as effective as traditional in-person treatments,” said Jennings.

This past fall the USDA launched an interactive data tool aimed to help communities build grassroots strategies to stem the opioid epidemic, to help rural leaders make data-driven decisions for their communities.

The USDA invites leaders to see the many ways your community can partner with USDA to meet immediate needs in this fight. According to the USDA, their program resources can help rural communities address many of the deeper, systemic, and long-term issues making these places vulnerable to the opioid crisis in the first place, the agency notes. Their infographic illustrates how USDA can help rural communities respond to the opioid epidemic by addressing some of the root causes.

Interview with Dr. Heather Pedersen Brain–Health a Growing Concern as Boomers Age

The Center for Disease Control (CDC) announced their State and Local Public Health Partnerships to Address Dementia, The 2018- 2023 Road Map, as part of the CDC Healthy Brain Initiative. The Road Map helps chart a course for state and local public health agencies to prepare their communities to deal with the ever expanding need for brain-health concerns.

According to CDC and their Healthy Brain Initiative, there are at least five to six million people currently living with age-related dementias in the U.S. This translates into one out of every six women and one out of every 10 men, who live past the age of 55. As the population increases, and more Baby Boomers reach older ages, these numbers are expected to rise.

The CDC wants to stimulate changes in policies, systems, and environments. They convened experts who developed 25 actions for public health leaders to promote brain health, better care for people with cognitive impairment, increased attention to caregivers, and efforts to build public health capacity.

“Dementia is a devastating condition that impacts millions of people annually,” said Dr. Heather Pedersen, a board certified clinical neuropsychologist at the Algiers Neurobehavioral Resource, LLC, located in New Orleans.

“Dementia,” she said “is a generic term that refers to when an individual is experiencing cognitive problems––such as memory loss, difficulty with logic, or trouble with language––to such an extent that they cannot manage aspects of daily life.”

According to the CDC, while there are various forms of dementia, around 70 percent of cases are due to Alzheimer’s and the next most common type is vascular dementia. African Americans, Hispanics, and women are particularly at risk of developing Alzheimer’s and other dementias. More than 95% of people with dementia have one or more other chronic conditions. And, one in three Alzheimer’s caregivers report their health has become worse due to care responsibilities.

“There are many diseases and conditions that can lead to dementia,” Pedersen said, “with Alzheimer’s disease being the leading cause of dementia. Per the CDC, the number of adults with Alzheimer’s disease is expected to triple over the next 40 years. Alzheimer’s disease and other dementiacausing diseases impact individuals, families, friends, caregivers, health-care agencies, and communities in wide-ranging ways,” Dr. Pedersen said.

According to the CDC, they seek to promote the use of effective interventions and best practices to protect brain health, address cognitive impairment, and help meet the needs of caregivers for people with dementia. They aim to improve inclusion of healthcare quality measures that address cognitive assessments, improve the delivery of care planning to people with diagnosed dementia, and improve outcomes.

Another of the CDC’s goals is to educate public health professionals about the best available evidence on dementia, including detection. CDC Director Robert R. Redfield, MD, said. “Early diagnosis is key to helping people and their families cope with loss of memory, navigate the health care system, and plan for their care in the future.

“The importance of early detection and intervention for many dementia processes cannot be overstated,” Dr. Pedersen explained. “Some medications are more effective when started earlier and compensatory strategies can often be put into place so as to be more useful in the long run. However, in order to be able to put these interventions into place, an individual has to first be diagnosed with dementia.”

What are some of the benefits of early diagnosis of dementia?

“Early diagnosis of course allows for individuals to begin appropriate medication earlier on in the process, as there are medications for certain diseases, like Alzheimer’s, that can slow down the disease process. But, early diagnosis also allows for individuals and their families to begin to adjust and adapt their lives in ways to make good years last as long as possible,” Dr. Pedersen said. “By making slight changes to schedules, home management, or other systems, individuals can maintain independence for as long as possible.”

Can neuropsychologists’ findings help with treatments and/or treatment planning?

“Absolutely,” Pedersen said. “By helping with an accurate diagnosis, neuropsychologists can also help other providers make informed decisions about treatment options. Neuropsychologist evaluations also help by determining individual’s cognitive strengths and weaknesses,” she said.

“By maximizing strengths to compensate for weaknesses, neuropsychologists can help make suggestions to make tasks more efficient or easier to complete.”

Neuropsychologists can often help caregivers better understand issues for their loved ones and better cope with and adjust to the caring role.

“It is often very helpful for caregivers and other family members to understand the basics about what is causing the cognitive problems or dementia,” Dr. Pedersen explained. “As part of the evaluation process, clients and loved one’s are provided with feedback about what is likely causing their cognitive problems. We spend time discussing the causes, prognosis, treatments, and other strategies that might be helpful in maximizing the client to live their best life.”

In today’s medical culture, the approach is often the quick screening rather than the comprehensive assessment. Is this a concern? A quick screening may not be able to determine the cause of an individual’s cognitive problems, Pedersen explained.

“A comprehensive assessment is critical in the accurate diagnosis of dementia. There are many conditions that can masquerade as dementia and given the permanent, progressive nature of some dementias, it is vital that one isn’t falsely diagnosed,” she said. “There are many different diseases and conditions that cause dementia, some of which are treatable and some of which are not. Depression and some metabolic conditions can ‘look like’ dementia, but in fact are treatable conditions.”

The American Academy of Neurology (AAN) has recommended neuropsychological testing since 1996 for patients who may have experienced a traumatic brain injury, a stroke, Parkinson disease, multiple sclerosis, a neurotoxic exposure, or dementia. Neuropsychological testing “is particularly valuable in distinguishing between normal aging and mild dementias,” they AAN noted.

Dr. Pedersen, who earned her PhD from the University of North Dakota, and completed her postdoctoral fellowship in clinical neuropsychology at the Memphis Veterans Affairs Medical Center and UT Health Sciences Center Consortium, is licensed in Louisiana, Minnesota, and Arizona.

Among her training and research achievements, Dr. Pedersen has co-authored “The next major neuropsychological and neuropsychiatric breakthrough: Alzheimer’s disease,” for the Handbook of Neuropsychiatry Research. She also co-authored research on concussions for American Journal of Alzheimer’s Disease and Other Dementias, and co-authored “Later life health optimism, pessimism, and realism: Psychosocial contributors and health correlates,” published in Psychology and Health.

“Each person who walks through my door is a unique constellation of traits, strengths, and weaknesses, who is looking for some sort of assistance,” Dr. Pedersen said. “I find it very satisfying to come along side each client to work with them in their treatment goals.”

“That process of collaborating with my clients is a very enjoyable process for me,” she said.