Sunday, April 29, 2012

The Sunflower and Forgiveness

( SPOILER WARNING: Read Simon Wiesenthal's "The Sunflower: On the Possibilities and Limits of Forgiveness" before reading this post )
It is believed that there is no truly perfect person without some sort of blemish requiring forgiveness in one way or another. Most religions teach us that forgiveness of other people is key to either providing a healthier life or a rewarding afterlife. In Buddhism, forgiveness is a practice for removing unhealthy emotions that would otherwise cause harm to one’s mental well being. According to the Bible, people should bear with each other and forgive whatever grievances they may have against one another while forgiving “as the Lord forgave them” (Col 3:13). However, not everyone believes that forgiveness is necessary. Some think that forgiveness should be earned through remorse or through punishment. Others believe that forgiveness should be left up to God because it is too much of a burden for one person to bear. Regardless of what one’s opinion may be, while opening The Sunflower for the first time, one can’t help to ponder on the possibility of forgiveness. However, it is only after reading the book in its entirety and allowing Simon Wiesenthal to provide a vivid landscape of the circumstance in which he faces and shows what it’s like to be a prisoner, what it’s like to be a soldier, how much human nature and remorse exist in the dying soldier, and how other people react to the story, one might to start doubt or question their view of forgiveness and wonder if it really would be possible or not.
During the first few pages of the book, Simon paints the picture of what each prisoner must endure. In describing how the SS tortured the prisoners, he said the following: “They usually hid behind the huts and whenever they felt like it they swooped like birds of prey on the helpless prisoners. Every day some were injured; it was part of the ‘program’” (3). The “program” was what all prisoners faced from day to day. At night, they were so exhausted that some didn’t even bother taking off their boots and they often slept in their sweaty clothes. As they slept, they barely had enough air to provide oxygen for the hundred and fifty men who lay penned together on the tiers of bunks (5). With the debate of Author and Josek over whether God could’ve created both the Nazi and the Jewish race from the same “clod of earth” (6) and the story of the old woman who said that she “thought that God was on leave” (8), Simon shows that the conditions for the prisoners were so bad that even their deepest religious faiths had been shaken. But, in presenting the uncertainty that each day would bring by talking about “registrations”, one can really start to understand what terrors the prisoners faced.
These registrations involved new dangers that were quite unimaginable in normal life. The oftener they registered us, the fewer we became. In SS language, registering was not a mere stocktaking. It meant much more: the redistribution of labor, culling the men who were no longer essential workers and throwing them out—usually into the death chamber. From bitter personal experience we mistrusted words whose natural meaning seemed harmless. (9)
To be a prisoner during the Holocaust meant to be underfed, tortured, and kept barely alive. Prisoners were robbed of any self-worth and the sicker they became, the more likely that they would be removed from their group and gassed or even shot in the head without a moment’s notice.
Soldiers, on the other hand, were treated quite well.  It was evident when Simon was walking past the cemetery and noticed a sunflower planted at each grave. In comparing the prisoners to the soldiers, he writes the following:
Suddenly, I envied the dead soldiers. Each had a sunflower to connect him with the living world, and butterflies to visit his grave. For me there would be no sunflower. I would be buried in a mass grave, where corpses would be piled on top of me. No sunflower would ever bring light into my darkness, and no butterflies would dance above my dreadful tomb. (14)
Even in death, soldiers were treated with more respect. Each soldier’s grave was adorned with a sunflower to serve as an eternal connection to the outside world and an excuse for butterflies to visit the tomb regularly. The Jewish prisoners, however, only had the possibility of being buried in a mass grave to eagerly anticipate. Simon is jealous because his life is so awful, even in comparison to the dead Nazis.
            But when Simon is taken to the bedside of the dying soldier, Karl, one can start to see the human nature and remorse of the soldier. He talks about his Catholic upbringing and how he was actually a server in the church and a special favorite of their priest. (30) The priest had hoped that Karl would study theology one day. (30) Seeing how Karl once had a mother and father that cared for him very much and didn’t want to see him join the SS also made the German soldier appear more human. (32) Karl said of his mother, “In my mother’s memory I am still a happy boy without a care in the world… full of high spirits. Oh, the jokes we used to play…” (34). After Karl said this, Simon thought of his own youth and the jokes that he used to play.  As Karl explains his first contact with the enemy, one might start to develop and understanding of what pressures the soldier was facing and how helping the enemy or turning back might not be an option:
“The fighting was inhuman. Many of us could hardly stand it. When our major saw this he shouted at us: ‘Believe you me, do you think the Russians act differently toward our men? You need only see how they treat their own people. The prisons we come across are full of murdered men. They simply mow down their prisoners when they cannot take them away. He who has been selected to make history cannot be bothered with such trifles.’” (38)
The remorse of the dying soldier became evident when Karl started telling the story about the Jews being killed in the house:
“When we were told that everything was ready, we went back a few yards, and then received the command to remove safety pins from hand grenades and throw them through the windows of the house. Detonations followed one after another… My God!” (43)
But the particular family that the dying man saw was the most disturbing and was the object of the most remorse, “’I can see the child and his father and his mother’” (47). It was apparent that the family made a lasting impression on Karl. And Karl was not the only soldier that the memory had haunted. It is the one thing that his comrade, Peter, mentions as he takes his last breath after having been wounded on the battlefield. His friend had suffered greatly by taking the memory of the house full of Jews to his grave. Karl, on the other hand, wanted to rid himself of the memories and was willing to confess to Simon in hopes that it would help.
            According to Karl, it appeared that the whole reason for his being in the hospital was that he could not stop thinking about the family of Jews. In recalling the injury, he says, “In that moment I saw the burning family, the father with the child and behind them the mother – and they came to meet me. ‘No, I cannot shoot them a second time.’ The thought flashed through my mind… And then a shell exploded by my side. I lost consciousness” (51). He was obviously showing remorse in that instance. Simon specifically addresses it when he sums up the confession:
Here is a dying man – a murderer who did not want to be a murderer but who had been made into a murderer by a murderous ideology. He was confessing his crime to a man who perhaps tomorrow must die at the hands of these same murderers. In his confession there was true repentance, even though he did not admit it in so many words. Nor was it necessary, for the way he spoke and the fact that he spoke to me was a proof of his repentance. (53)
So, when the act is considered by itself, it may seem clear that the SS should not receive any forgiveness at all. However, when one mixes into the act a son of a loving mother who never really wanted to be a murderer of innocent Jews, someone who really never would’ve considered committing the murder if not for the command he was under, and someone who could not bear to live another moment with the thoughts of the dead Jews, one has to take a step back. What was not so forgivable before now seems to be a little more complicated.
            The possibility of forgiveness, however, gets more difficult when one examines Arthur Hertzberg’s reaction to The Sunflower. Arthur was a rabbi who practiced conserving the Jewish traditions. In his reaction, he says that Simon must not have remembered “the teachings of the Talmud in that no one has the right to commit murder even if he is sure that he himself will be killed for not complying with such an order” (166). If he had remembered, he would not have even struggled with the question. To Arthur, forgiveness was not a possibility. He makes this point clear when he says,  “Wiesenthal said nothing, and he was right. The crimes in which this SS man had taken part are beyond forgiveness by man, and even by God, for God Himself is among the accused.” How could Arthur’s reaction be so absolute? One has to wonder if he would have made the same choice if he were put in the same situation as Simon; or better yet, what choices he would’ve made had he been born a German soldier. Would he have chosen to disobey the commanding officer if given the chance? Can the dying soldier be condemned for the misfortune of not knowing the teachings of the Talmud?
            There is also the reaction of Mathew Fox to consider. His reaction is like that of many others. “There are sins that God and no humans must forgive” (146). Mathew’s reaction is unique in the sense that, to him, Simon’s silence was more of a penance. Mathew writes the following:
He gave Karl the only penance available to him to bestow: Silence. The penance of Karl’s having to be alone with his conscience before he died.  Simon did not offer him forgiveness as a Jew – how could he forgive in the name of even one in the home of hundreds who were torched or the millions in camps of death? But Simon, summoned as a priest-confessor, let the man speak his heart. Some sins are too big for forgiveness, even for priests. (144)
Mathew thinks that Simon gave to the dying soldier all that he had to give: compassion (145). By listening to the dying man and by holding his hand even though the thought repulsed him as more of the story was revealed, Simon showed he was being present and human (145). Mathew also attributes his life’s vocation after the Holocaust to the deathbed confession when he says, “Simon does not condemn the criminals he uncovers; he leaves that up to the judge of the courts. He only provides the witnesses, the testimony, the evidence. They convict themselves. As did Karl” (146). But then, Mathew relates the story to present time. He says that the story may disturb us so deeply is because it is a true morality story and that it applies today as much as to yesterday (147). The fact that so many people allowed the sins to be committed makes them equally guilty. Mathew points out the fact that Simon held Karl’s mother in the same category of guilt as Karl, “Simon treated mother and son the same – he listened to both and left both in silence” (147). But Mathew goes on to take the position that forgiveness should occur for the good of oneself. According to Mathew, one should forgive, but never forget (148).
            It is only after the careful consideration of the circumstances that one can begin to comprehend the dilemma Simon had faced in being asked for forgiveness. When we read about what a Holocaust prisoner endured from day to day through the eyes of Simon Wiesenthal, we start to understand the silence that Simon gave the dying SS soldier. When we learn that prisoners are underfed, tortured, and tormented with the thought of death at a moment’s notice, we realize that forgiveness is not quite as easy as we thought despite the fact that some religions say we must forgive if we are to be forgiven. One cannot help but to feel even more animosity toward the German soldiers as we learn that each soldier’s grave has a sunflower growing out of it which, even in death, allows an eternal connection to the living world. For Arthur Hertzberg, it would be an absolute choice of no forgiveness – not even from God himself.  This decision was made from someone who was not involved in the Holocaust at all and was, instead, moved to the United States before it occurred. Most others are not so quick to discount forgiveness all together. Mathew Fox feels that forgiveness should be given – if only for the healing of the forgiver. To Mathew, it’s fine to forgive, but we must never forget. Forgiveness may also become more possible when we farther consider the soldier’s human nature and remorse he shows in telling his story. Simon and Karl are brought together as victims of other leader’s rules. Both are suffering in different ways. Whether someone should forgive or not can forever be debated and is still a matter of personal opinion. The fact that Simon has helped us to look deep into our hearts to consider forgiveness is not debatable. When people truly try to consider the circumstances given in the book, they sometimes find themselves conflicted with what they initially thought would do. In The Sunflower, Simon gets us as close to considering both sides of the story as possible and helps us to realize that things are not simply black and white.

Friday, April 6, 2012

Ethics in 60 Minutes

Different people behave in many different ways. Whether making a decision to cut someone off in traffic or give a dollar to someone begging for money, people are constantly weighing their decision to perform an action based on whether that action is the right or wrong thing to do. But what makes a particular action right or wrong, and who is the ultimate judge of that action? Ethics dictate the moral principles or philosophies of how we behave. While one philosophy may seem, at times, to be more right than another, all philosophies can be correct depending on the point of view used. The Insider is a good example of a movie illustrating all four ethics philosophies: relativism, egoism, utilitarianism, and deontologism in uncovering some of the hidden secrets of big tobacco.
Relativism is an ethical concept with no absolute truth or validity. It only has relative or subjective value according to differences in perception of consideration. According to relativism, people behave the way they do because of their historical or cultural context. If they act a certain way, it is because the society that surrounds them has made them the way they are. Any and all actions are justified under a relativistic point of view. When one relativistic person finds agreement with another, as in groupthink, it sometimes makes relativism seem more justified. When faced with a decision, people acting under a relativistic philosophy will do practically anything they want as long as they can somehow rationalize it. One problem with relativism might be the justification of something like the Nazi Holocaust in the killing of Jews, homosexuals, and disabled people.
            According to The Insider, the “seven dwarfs” seemed to convince themselves that what they were doing was ethically right. They had been programmed to believe that cigarettes were not harmful or addictive. The entire culture of tobacco business believed this way for many years and often emphatically denied anything to the contrary.
Egoism is an ethical philosophy where people look out for their own welfare above all others. People acting under an egoistic philosophy will find justification in anything that maximizes their self-interest, and they will believe that everyone else is also acting in their own self-interest as well. When faced with a decision, people acting under the egoistic philosophy will always do what benefits them the most. One problem with egoism might be that many people could potentially suffer at the expense of bringing happiness to oneself.
According to the movie, Liane Wigand repeatedly exhibits behavior of someone operating in an egoistic way. For example, when confronting Jeffrey Wigand after he was fired, she was only concerned in her own comfort and how the things that she had grown accustomed to would be taken away. Instead of supporting Jeffrey through the testimony and interviews that would eventually protect the safety of so many people, she decided to leave him.
Mike Wallace also acted egoistically when he refused to support Lowell in his efforts to get Wigand’s interview televised. He was basing his decision primarily on his own self-interest in he was more concerned about how he would be remembered once he retired. Later on, however, he changed his philosophy and started working with Lowell in a utilitarian way.
Utilitarianism is an ethical philosophy that posits the proper course of action should be that which maximizes overall “happiness”. It differs from egoism in that the goal is to benefit as many people as possible without self-interest in mind. Sometimes, even seemingly wrong acts can be viewed as right when they will result in benefiting a greater number of people. When faced with complex decisions, people acting under the utilitarian philosophy will always choose to do what produces the greatest amount of good to the greatest amount of people or the least amount of bad to the least amount of people. One problem with holding a utilitarian point of view might be that an occasional theft from a rich man or an occasional lie to avoid embarrassment could both be considered justifiable actions.
In putting the safety of the public ahead of those needs of his family, Jeffrey Wigand was definitely practicing utilitarian ethics. Even though he knew he was risking the health of his daughter and he could have gone to jail upon returning home, he decided to put his statement on record. This selfless act was done undoubtedly for the greater good of the public.
As the thought of CBS being sued was weighed against the airing of the interview, one might infer that Don Hewitt was acting in a utilitarian way. He was definitely looking out for the good of many over the good of one individual. In this case, Wigand’s reputation and family was destroyed, but that didn’t convince Hewitt to allow the interview to be shown.
Deontologism maintains that the moral rightness or wrongness of an action depends on its intrinsic qualities, and not on the nature of its consequences. Deontological ethics holds that at least some acts are morally wrong in themselves (e.g., lying, breaking a promise, punishing the innocent, and murder). When someone is acting under deontological ethics, they make decisions based solely on their actions with no regard to the consequences.  One problem with deontologism might be that, according to deontologists, it makes no sense to give up one’s place in the next world to save another life if it means having to lie.
When Lowell Bergman decided to give his story to the New York Times, he was acting according to deontologism. In doing so, he did what he thought was the right thing to do. He had previously given his word to Wigand that he would follow through and would help him until the end. Not concerned with the consequences of whether one or more people would be affected, he based his decision solely on the fact that the action was the right thing to do.
Ethically speaking, The Insider was packed full of examples of different philosophies at work. Relativism, egoism, utilitarianism, and deontologism were all shown. In fact, most disagreements or conflicts we face every day arise due to fundamental disagreements in the way people ethically perceive situations. When people practicing different ethic philosophies don’t agree on what is considered the right thing to do, it’s sometimes impossible to come to a resolution. This was definitely the case in the movie. Eventually, however, things worked out for Wigand and his story was told.

Wednesday, March 28, 2012

Overcoming Social Anxiety

Most people have experienced some apprehension when faced with a social situation. Giving a speech may not come as naturally to some as to others, or some might feel butterflies in their stomach during a job interview. Sometimes, people may even feel a little nervous while speaking to a stranger or stumble over a few words while asking someone out on a date. Social anxiety, however, is more than just the shyness or discomfort someone would experience in those awkward situations. Social anxiety is such an intense fear of being embarrassed that people reluctantly endure those situations or they tend to avoid them all together.  To people who suffer from social anxiety, staying away from social interaction is often the path of least resistance. But, no matter how intense the feelings of anxiety are, there is still hope. By understanding the causes including culture, society, neurological, or contextual conditioning, and by using one of the following treatments: social imagination, skills training, cognitive behavioral therapy, group therapy, or medication; people absolutely can overcome social anxiety.
The first step in treating social anxiety is to understand what causes it. Stefan G. Hofmann, PhD, and other contributors point out that the defining feature of social anxiety is the fear of negative evaluation of others (1117).  Because of this, it is directly linked to social standards and role expectations, which are culturally dependent (Hoffmann et al. 1117). Social organizations that emphasize the interdependence of its members are referred to as collectivistic. Those that reward individual achievement and success over those of the group are individualistic. It should be apparent that collectivistic societies tend to have a lower occurrence of social anxiety because there is normally not as much evaluation of individuals. People living in Asia will be less likely to experience social anxiety, while people living in Russia and the United States will be more likely to experience social anxiety (Hoffman et al. 1124).
But what, specifically, causes the fear? Heidemarie Blumenthal and her colleagues at the University of Arkansas show us that as with most other psychological diagnoses, adolescence is a key period in the development of social anxiety (1134). During puberty, there is profound psychosocial development as youths experience extensive physical growth and developing of primary and secondary sexual characteristics (Blumenthal et al. 1134). Also, during this time, youths will reach skeletal maturity and attain reproductive capability (Blumenthal et al. 1134). These intense changes set the stage for the future vulnerability of social anxiety symptom manifestation (Blumenthal et al. 1134). As adolescents become more unfamiliar and more conscientious about their changing body and moods, a greater potential exists that their social interactions will be negative.
From this early negative social interaction, an exaggerated fear response will develop. Sabin G. Shah, a graduate student at Tufts University, and others illustrate how the brain structures of the amygdala and insula react to negative stimulus in patients suffering from a generalized social anxiety (296). From their experiment, it was found that the generalized social anxiety is normally associated with a negative affectivity in that negative facial expressions and negative images yielded more of a reaction to the brain structures than positive ones (Shah et al. 301).  In other words, people suffering from social anxiety are much more aware and much more sensitive of the negative social interactions than the positive social interactions. This negative affectivity continuously feeds the social fear as they imagine the worst and try to avoid social interactions entirely.  
Contextual conditioning is also at work. Joannie M. Schrof, an author for U.S. News & World Report, observes that a fear “marker” is attached to the details of a situation in which the trauma was experienced (e.g. place, time of day, background music) (50). If, for example, children get tongue-lashings from a teacher, they will feel nervous the next few times they step into the classroom (Schrof et al. 50). Unfortunately, the brain is sometimes too good at making associations and the anxiety “grows like a cancer”, attaching itself to the act of entering any classroom or talking to any teacher and thus generalizations are made (Schrof et al. 50). While this “weariness of other creatures” has contributed to the overall survival of the human race, it also plays a large role in the generalized social anxiety that people so often experience even though there is often no threat at all (Schrof et al. 50).
So, what can be done to reduce social anxiety to a manageable level or to eliminate it all together? First of all, the patient needs to be retrained or rewired. If they are expecting the worst when interacting with others, they have to, instead, be trained to expect something other than the worst. Remember, the goal is to fight the belief that others will pass negative judgment and unbearable humiliation will result (Schrof et al. 50). We can accomplish that through many different methods.
One method is called sociological imagination. This encourages patients to seek understanding as it relates to the larger historical picture. In “It’s Not My Fault: Overcoming Social Anxiety through Social Imagination”, the author takes us through a tour of his life and the things that may have contributed to the anxiety he struggles with (42). In understanding how society has contributed to his social anxiety, he can better cope with it. He walks us through his military life as a child and explains how being sent to many different military bases hurt him instead of helping with socialization skills (“Fault” 42).  He took on different roles as a child and treated the world as a theatre, shying away from who he really was to avoid embarrassment (“Fault” 43).   Eventually, not confronting his fears caused him to avoid all types of social contact (“Fault” 47). Later on in life, however, he became very capable of dealing with social anxiety (“Fault” 47). Looking inside one’s own thoughts and seeking understanding for the external forces that affect us can be a very important first step in conquering social anxiety.
Another method to treat social anxiety is to develop certain skills. Robin F. Cappe and Lynn E. Alden, PhD, explain how important it is for patients to not have their attention focused on themselves (796). They believe that the majority of the anxiety comes from not being able to effectively interact with other people and emphasize four very important skills to help: active listening, empathetic responding, communicating respect, and self-disclosure (Cappe and Alden 796). These same skills are commonly taught in human relations training, but modified to apply to social interactions with friends.
One such skill is active listening. Lucetta B. Comer and Tanya Drollinger, with the Department of Consumer Sciences and Retailing at Purdue University, define active listening as a process in which the listener receives messages, processes them, and responds so as to encourage further communication (15). In active listening, we must include both verbal and non-verbal messages including body positioning, eye contact, facial expressions, and emotion (Comer and Drollinger 15). Being an active listener means that you provide verbal and nonverbal feedback to the speaker such as acknowledgements that you understand what is being said (Comer and Drollinger 15).
Empathetic responding, an advance method of acknowledgement, is another useful social skill. Empathy is defined as understanding another person’s thoughts and feelings with some degree of accuracy (Comer and Drollinger 15).  It involves listening on an intuitive as well as literal level (Comer and Drollinger 15). To respond with empathy gives speakers a sense that you understand what they are saying. Once they feel that you “get them”, they are more encouraged to open up. Being able to empathize with someone takes the attention away from you and helps to relieve social anxiety.
A skill commonly overlooked would be communicating respect to someone in a social interaction. Kyu-Taik Sung, president of Elder-Respect, Inc., and Ruth E. Dunkle, Professor of Social Work at the University of Michigan, describe respect as a benevolent, altruistic, or sympathetic expression of regard for other persons (251). Respect calls for more than one’s attention (Sung and Dunkle 251). Communicating respect means using courteous manners, using respectful language, and treating others as you would want to be treated (Sung and Dunkle 253).
The last skill of self-disclosure is revealing more about oneself to others. Rimantas Koclunas, a Professor of Clinical Psychology at the University of Vilnius and Tatjan Dragan, a psychologist from the Psychology Section of the Lithuanian Police Department Personnel Board, describe self-disclosure using two aspects: the “here-and-now” and historical “there-and-then” (346). There are also two types of disclosure: disclosing personal information such as personal difficulties, unresolved problems, aims and wishes, strong and weak points of your personality, positive and negative experiences; and the ability to share reactions to the events occurring immediately in the conversation (Koclunas and Dragan 346). When you practice self-disclosure, you develop established conditions of trust, interpersonal warmth and support in your social interactions (Koclunas and Dragan 349).
Cognitive Behavioral Therapy is another method for controlling social anxiety. One psychologist will take patients to an elevator where she asks them to ride up and down and make small talk with fellow passengers (Schrof et al. 50). Sometimes it takes 10 or 15 rides, and sometimes it takes all day, but eventually, the patients’ hearts stop racing for fear of what the people in the elevator think of them (Schrof et al. 50). Putting patients in embarrassing situations or situations that would normally elicit social anxiety helps them confront their biggest fears and eventually deal with them. If they have enough experiences that are positive, they will eventually extinguish their fears of social anxiety. This social exercise of engaging others until it is second nature is much like our gym workouts to stay physically healthy (Schrof et al. 50).
            This particular behavioral therapy is a form of in vivo exposure. Ronald M. Rapee, a professor in the Macquarie University Department of Psychology, describes in vivo exposure as a cognitive restructuring individually tailored to target the specific social fears of the patient. Patients start with tasks that cause little or no discomfort and eventually work up to more strenuous activities. Eventually, they are able to conquer their biggest social phobias (Rapee et al. 320).
Over the years, group therapy has been found to be a good treatment for a variety of disorders. It can, however, be especially helpful in treating social anxiety. The group setting itself encourages social interaction. Since others in the group share your anxiety, you are likely to receive less negative evaluations. In group settings, you are able to easily practice the skills that will make you more comfortable with social interaction. Diane Damer, a psychologist from the University of Texas at Austin, and colleagues explain that the cost benefits of group therapy are far greater than those of individual therapy. There also is mounting evidence in studies that group therapy can prove to be more effect (Damer et al. 10). 
In some cases of social anxiety, one might also turn to medication.  As outlined in the article “Treating social anxiety disorder” from Harvard Mental Health Letter, selective serotonin reuptake inhibitors (SSRIs) and one serotonin and norepinephrine reuptake inhibitor (SNRI) are considered the best medical options for the generalized form of social anxiety disorder (1). However, if there is a specific social phobia, beta-blockers or benzodiazepines should first be considered (“Treating” 1).
Serotonin is a neurotransmitter used by your body to regulate mood, sleep, appetite, and pain sensation. Reduced serotonin transmission contributes to anxiety. SSRIs such as citalopram (Celexa), paroxetine (Paxil), and sertraline (Zoloft) increase the availability of serotonin thereby decreasing social anxiety (“Treating” 2). Venlafaxine (Effexor) is an SNRI that targets not only serotonin, but also norepinephrine. Norepinephrine is also known as adrenaline (“Treating” 2).  Coincidentally, SSRIs are also used to treat depression. In comparison, only half the dosage used to treat depression is used in treating social anxiety (“Treating” 3).
To medically treat the specific phobia of public speaking, doctors will sometimes prescribe beta-blockers. Although, these are typically prescribed patients with heart disease, beta-blockers like propranolol (Inderal) can help to counter symptoms of social anxiety, such as sweating, rapid heartbeat, or shortness of breath (“Treating” 3). Several studies suggest that taking this type of drug about an hour before speaking, this can greatly reduce the effects of social anxiety (“Treating” 3).
Benzodiazepines are another medication used to treat specific social anxiety disorders. They work by boosting the activity of gamma-aminobutyric acid, which is an “inhibitory” neurotransmitter (“Treating” 3). In other words, it suppresses signals that are traveling down a neural pathway (“Treating” 3). This will have a calming effect on anxiety symptoms. Unfortunately, people taking benzodiazepines can become physically dependent upon them and there is some potential for abuse.
When it comes to social anxiety, there are many treatment options available. In a world of computers and smart phones, social interactions are not as common as they once were. Where there used to be a natural “overcoming of shyness”, people are more inclined to take the easier path and avoid these situations. That’s why it’s so important to recognize the causes of social anxiety as well as the treatments available. Whether someone uses social imagination, skills training, cognitive behavioral therapy, group therapy, or medication, there should be no reason for anybody to suffer; overcoming social anxiety is absolutely possible.

Works Cited

Blumenthal, Heidemarie, et al. “Elevated Social Anxiety among Early Maturing Girls” Developmental Psychology 47.4 (2011): 1133-1140. Print
Cappe, Robin F., and Alden, Lynn E. “A comparison of treatment strategies for clients functionally impaired by extreme shyness and social avoidance” Journal of Consulting and Clinical Psychology 54.6 (1986): 796-801. Print
Comer, Lucetta B., and Drollinger, Tanya “Active Empathetic Listening and Selling Success: A Conceptual Framework” Journal of Personal Selling & Sales Management 19.1 (1999): 15-29. Print
Damer, Diana E. et al. “Build Your Social Confidence: A Social Anxiety Group for College Students” Journal for Specialists in Group Work 35.1 (2010): 7-22. Print
“It’s Not My Fault: Overcoming Social Anxiety through Sociological Imagination” Journal of the Sociology of Knowledge 2.1 (2003): 42-49. Print
Hoffman, Stefan G., et al. “Cultural aspects in social anxiety and social anxiety disorder.” Depression & Anxiety 27.12 (2010): 1117-1127. Print
Koclunas, Rimantas, and Dragan, Tatjan “The Phenomenon of Self-Disclosure in a Psychotherapy Group” Journal of the Society of Existential Analysis 19.2 (2008): 345-363. Print
Rapee, Ronald M., et al. “Testing the efficacy of theoretically derived improvements in the treatment of social phobia” Journal of Consulting and Clinical Psychology 77.2 (2009): 317-327. Print
Schrof, Joannie M., et al. “Social Anxiety” U.S. News & World Report 126.24 (1999): 50. Print
Shan, Sabin G., et al. “Amygdala and insula response to emotional images in patients with generalized social anxiety disorder” Journal of Psychiatry & Neuroscience 34.4 (2009): 296-302. Print
Sung, Kyu-Taik, and Dunkle, Ruth E. “How Social Workers Demonstrate Respect for Elderly Clients” Journal of Gerontological Social Work 52.3 (2009): 250-260. Print
“Treating social anxiety disorder” Harvard Mental Health Letter 26.9 (2010): 1-3. Print

Sunday, March 4, 2012

Antidepressants are Overprescribed

Depression is a feeling of impending doom or hopelessness.  When multiple symptoms are found to persist for long periods of time, one may be diagnosed with major depressive disorder. Other forms of depression may be mild or temporary. Dr. J. Michael Bostwick, M.D., an expert in Psychiatry at Cambridge Hospital, points out that mild depression occurs throughout the normal course of life when, for example, someone experiences a death of a family member, has trouble adjusting to a new environment, or suffers from dysthymia (538). Antidepressants are usually the first line of defense used to treat depression and are sometimes found to be necessary, but they have become far too accessible. Antidepressants should not be considered the cure-all solution for all forms of depression because there are many more beneficial alternative forms of treatment with less unwanted side-effects.
Antidepressants are medications used to reduce the effects of depression. Dr. Morgan Sammons, PhD, who is currently the dean for the California School of Professional Psychology at Alliant International University, observes that the rate of suicides has decreased since antidepressant use has become widespread (327). In many cases of major depressive disorder, changing the chemistry of the brain through the use of medicine appears to be the best solution. George Sims, a journalist from Countryside Magazine, swears that antidepressants were the only solutions to his problems (101). Dr. Jeffrey C. Danco, PsyD, a clinical psychologist, found that in 1998, over 60 million prescriptions were written for Prozac, Zoloft and Paxil (10). More recent statistics show that antidepressants have become the most popular pharmaceutical, with 118 million prescriptions in 2005 (Danco 10). There is undoubtedly great benefit found in the use of antidepressants for the treatment of some forms of depression.
There are, however, many side-effects to using antidepressants including drowsiness, dry mouth, nervousness, anxiety, insomnia, decreased appetite, nausea, headaches, long-term weight gain, cognitive impairment and decreased ability to function sexually (Bostwick 543). These side-effects fall into two basic categories: short-term and long-term. Short-term effects can be felt during the first few weeks of use and before the antidepressant starts to relieve the depression, while long-term effects are felt later and once the depression starts to subside.
With most antidepressants, people may experience nausea or a dull headache during the first few weeks (Bostwick 543). Bupropion can cause jitteriness and fluoxetine can cause nervousness, anxiety, agitation, insomnia, low energy, and fatigue (Bostwick 543). These early side-effects sometimes discourage the continued use of antidepressants. Sleep may also become a problem and the patient may be prescribed a benzodiazepine to assist, which can be very addictive (Bostwick 544).
As the antidepressant effects start to be felt, patients can lose control of their sexual functioning; thus upsetting the patient and sometimes discouraging the continued use of the antidepressant (Bostwick 453). Weight gain can later show up as eating or exercise patterns change (Bostwick 453). Since the loss of sexual function and weight gain can sometimes be the causes of depression itself, these effects ironically act against the antidepressant. This may be part of the reason that stopping the medication can become more difficult in the future. Tiffany Kary, a journalist for Psychology Today, explains how withdrawal from antidepressants is sometimes nearly impossible, causing confusion, vomiting, and suicidal impulses (15).
Also, one has to question the placebo effect of antidepressants in treating depression. People suffering from depression usually feel that they are out of control of their own life and that drugs will sometimes give them the sense of control they are lacking (Danco 11). Sometimes people will start to feel better before the first antidepressant has even been swallowed just because they think they will feel better (Danco 13). Because the side-effects of antidepressants are so great, patients can not doubt the power of the medication and that power is sometimes mistaken to be treating the depression (Danco 13).
With all the adverse effects of antidepressants, one would assume that prescribing antidepressants would be handled with great care; however, caregivers will often reflexively prescribe them at the first sign of any mild depression. Instead, they should more accurately diagnose patients to be sure they are in need of antidepressants. They should first consider alternative forms of treatment including watchful waiting and psychotherapy. They should prescribe antidepressants when they are absolutely sure that other forms of treatment will not work.
Watchful waiting simply involves frequent visits with face-to-face contact to assess whether depression symptoms have resolved or more aggressive treatment is needed (Bostwick 539). According to the article, “Watchful waiting just as effective, less costly than newer antipsychotics for AD”, watchful waiting has been used effectively as a method of treatment for other illnesses such as Alzheimer’s disease and certain types of cancer (5). Watchful waiting is a very good solution if there is a diagnosis of mild or temporary depression or if the diagnosis is unclear. The patient should be carefully observed over a period of "4-to-8 weeks" (Bostwick 539). If, however, the condition of the patient does not improve or worsens, other forms of treatment should be considered.
Psychotherapy should be considered as one of the first forms of treatment for depression. During psychotherapy, a person suffering from depression will discuss the factors that may be causing the depression with a trained mental health care professional. The goal of psychotherapy is to uncover the root of the depression and discuss it openly. If behaviors and emotions contributing to depression are better understood, the chance for behavior modification or problem solving is much greater. Therapy techniques include cognitive behavior therapy, behavioral activation treatment, psychodynamic approaches, problem-solving therapy, interpersonal psychotherapy, and social skills training. Patients will learn, through therapy, to eventually cope with their depression and in some cases remove the factors causing it.
One study, conducted by Christopher F. Sharpley, PhD, shows that psychotherapy can biologically rewire the brain (603). The reward section of the limbic system is usually affected the most from depression (Sharpley 604). Some brain structure differences tend to be common in patients suffering from depression (Sharpley 604). The amygdala, for example, usually appears to be larger in volume while the hippocampus appears to be smaller. Psychotherapy has been found to reestablish limbic circuitry balance and cause the same measurements seen in those not suffering from depression (Sharpley 607).
However, psychotherapy takes extra effort by both the patient and the caregiver. For it to be of any benefit, the depressive patient must have an ability to work in a relationship absent serious regression or withdrawal (Ahola et al. 357). Unfortunately, depression is known for affective blunting that can seriously hamper the development of a workable treatment relationship (Ahola et al. 357). By starting with psychotherapy, patients are avoiding the unwanted side-effects of antidepressants while the caregiver can monitor the depression. The mental health professional can accurately diagnose the patient over time to determine if other forms of treatment are required, including antidepressants.
Proper diagnosis is extremely important in determining whether someone is in need of antidepressants. In a sample of 100 patients, 10 patients with depression will be correctly identified, 10 will be missed, and 15 patients who are not depressed will be falsely given the diagnosis (Bostwick 540). One of the main problems with diagnosis of depression is that primary care physicians are responsible for more than 75% of them (Bostwick 540). Given that depression is a mental illness, better diagnoses would come from referring depressed patients to mental health professionals.
To be diagnosed with major depressive disorder, a patient must exhibit a depressed mood or depressed pleasure as well as a substantial social or occupational impairment (Bostwick 539). Also, the patient must have four of the following symptoms: weight loss or weight gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or reduced energy, preoccupation with feelings of worthlessness or guilt, poor concentration or indecisiveness, or morbid or suicidal thoughts. These symptoms must last for at least two weeks (Bostwick 539). Patients experiencing symptoms less than these may be diagnosed with a mild depression and should not reflexively be prescribed an antidepressant.
With the right mix of medication, watchful waiting, and psychotherapy, people suffering from depression can become psychologically stable and live fulfilled lives. There are many side-effects from antidepressants and there are times when antidepressants can be the only solution. Watchful waiting is sometimes a way to monitor a patient while trying to diagnose accurately and waiting for the problem to go away. Psychotherapy can provide biological benefits as well as teaching the patient to better cope with depression. Psychotherapy takes effort by both the patient and the caregiver and is not as easy as the prescription of medication.  We cannot abandon antidepressants entirely as they do have their use and can be considered a good solution in many cases; however, with a little extra effort on part of the caregiver and the patient, other forms of treatment can be far more beneficial.

Works Cited

Ahola, Pasi, et al. “The Patient-Therapist Interaction and the Recognition of Affects during the Process of Psychodynamic Psychotherapy for Depression.” American Journal of Psychotherapy 65.4 (2011): 355-379. Print
Bostwick, J. Michael. “A Generalist’s Guide to Treating Patients with Depression With an Emphasis on Using Side Effects to Tailor Antidepressant Therapy.” Mayo Clinic Proceedings 85.6 (2010): 538-550. Print
Danco, Jeffrey C. “Why Psychiatric Drugs Work: The Attribution of Positive Effects Due to Psychological Factors.” Ethical Human Psychology and Psychiatry 10.1 (2008): 11-15. Print
Kary, Tiffany. “Are Antidepressants Addictive?” Psychology Today 36.4 (2003): 15. Print
Sammons, Morgan T. “Writing a Wrong: Factors Influencing the Overprescription of Antidepressants to Youth.” Professional Psychology: Research and Practice 40.4 (2009): 327-329. Print
Sharpley, Christopher F. “A review of the neurobiological effects of psychotherapy for depression.” Theory, Research & Practice 47.4 (2010): 603-615. Print
Sims, George. “Depression: a leaf with no color.” Countryside & Small Stock Journal 95.5 (2011): 98-101. Print
“Watchful waiting just as effective, less costly than newer antipsychotics for AD.” Brown University Geriatric Psychopharmacology Update 12.2 (2008): 1-6. Print