Hello darkness, my old friend.

I can appreciate the change of season by the end of summer. I am drawn to the orange, brown, maroon tones of fall fashion. I love to climb up on a chair to retrieve the crockpot that has been stored over the summer. Pumpkin, sweet potato and squash replace the tomatoes, zucchini and corn in the basket in the kitchen. Logs are collected and stacked up by the fireplace. The paddle board and outdoor furniture are tucked safely away from the elements. The outdoor shower pipe is shut off, hopefully in time for the first freeze.

This is the time of year when darkness sets in early, before we arrive home from work. The temperature is cold. The predominant color is gray. The decrease in of hours of natural sunlight is dramatic.

All of these external changes effect us internally. Humans and other animals are extremely sensitive to changes in the environment. This is a good thing, we want to be in tune with nature. We need to recognize the changes and adjust.

What happens to our bodies? There is an increase in melatonin and a decrease in serotonin. The melatonin increase causes us to be more sluggish and less energetic. The decrease in serotonin can result in a depressed mood. Even people who love the winter months may experience a wistful sense of the passage of time, a loss of the ease of walking out the door without preparation. Mild sadness or malaise may set in as the body adjusts.

The shift may also cause a more intense change in mood, referred to as Seasonal Affective Disorder or SAD.

The primary symptoms are:
Depression
Problems concentrating
Lack of energy
Increase in sleep
Carbohydrate cravings

It is basically major depression, with a seasonal pattern. If this sounds familiar and has happened more than two years in a row, you may have SAD. For some people it is mild and you know you can “ride it out” until spring. For others, get some help.

Light therapy is medically proven to treat SAD. These light boxes act to mimic natural light. The recommended dosage is 10,000 Lux (the same as sunshine) for 30 minutes in the morning. It is important to get a light that blocks damaging UV light, which is known to cause skin cancer. Tanning beds are not helpful for SAD (or for anything else for that matter).

As with most depression, psychotherapy, particularly Cognitive Behavioral therapy is proven to be helpful.

Many clinicians recommend antidepressants in addition to light therapy. I do, only if light therapy alone is not helpful. Medication therapy can start in November and stop in April, if this depression is clearly seasonal. Bupropion is often prescribed for SAD because it counteracts the weight gain and hyper-somnia commonly seen in SAD and has fewer sexual side effects. Consult your personal physician to decide whether medication may be right for you.

There is a known association between Vitamin D deficiency and depression. The current recommendation for adults who do not have regular year round sun exposure should take from 600-800 IU of vitamin D3 daily. Older adults who are confined indoors and other high risk individuals may require larger dosages.

A healthy diet high in Omega 3 has shown to improve mood and a sense of well-being. I do notice I eat much less fish in winter and may need to supplement the Omega 3.

Get outside when the sun is shining! Go for a walk, cross country skiing or ice skating. “Being in it” has helped me – from the warmth of the house it looks nasty out, once I’m outside I never regret it. It might still be nasty but I’m not letting it stop me! Lake Michigan is amazing in winter. As in summer, it is different every day, every hour.

Remember there is no such thing as bad weather- only bad gear! Invest in the right stuff for layering and there is no excuse.

Becoming a snowbird is an option for some – heading south, even for a long weekend, can recharge the system.

For those of us here, embrace the change. Accept that this is a time for turning inwards, for introspection and for quieting the body. I’m actually exploring the option of becoming a morning person (?). Unheard of! Going to sleep at 8 when it feels like midnight might work for me. It’s good to change it up.

I straddle my time between two very cold Wisconsin cities, Milwaukee and Madison. Maintaining hygge in both homes and in my car is my goal.

My winter regimen is to walk, write, knit, ice skate, make soap, eat curry and soup, take lavender baths, and drink hot toddies and port.

How do you cope with the winter?

Yes, Look Back

In this society, looking back is considered very uncool. We are encouraged to be in the present. The past is seen as an obstacle to moving forward. Reminiscence is considered a nostalgic waste of time.We should be looking ahead at the next new path.

I believe most of us are not looking back enough.

How much do you know about your family history? Maybe you know where your parents were born but what about your grandparents? Your aunts and uncles? Can you picture their family life?

I am going to tell you about an incredible experience. I’m going to talk about a pilgrimage, for lack of a stronger term. This word denotes a journey to a sacred place. Actually it can be a simple exploration of one’s lineage. My brother Steve, sister Rita, and I set out on a true pilgrimage to my dad’s birthplace. Steve, an extremely knowledgable historian/Holocaust researcher prepared the groundwork for us. He had fastidiously mapped out our father’s town to the point of fairly accurately locating his exact house. He outlined the path the family took to the concentration camp. My cousin Richard came along as our guide. His presence was invaluable for his multilingualism, personal experience and high entertainment value.

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What Happens in Vegas Does NOT Stay in Vegas

 

Today I reflect on what happened yesterday in Las Vegas. Nothing else seems relevant. 

What was he thinking? The police say he had no apparent motive.

Was the music too loud? 

Was it because he lost a lot of money gambling? 

Was he hearing voices telling him to shoot himself, meaning that he was psychotic?

As a psychiatrist, there is no way I can figure him out at this point. But what I can do is try to grapple with this tragedy myself.

Do we care about this just because it’s down home American country music fans in our beloved Las Vegas, the epicenter of fun and reckless abandon? Or is it because it breaks the record as our largest mass shooting? 

No. It enrages us because it is no longer an aberration. It has become the norm.

The causes will be investigated, new measures for security to prevent this in the future, blah blah blah. I will leave that for the experts, politicians and the press.

We immediately want to blame someone – ISIS, his mother, his psychiatrist, the gun shop, the hotel security. But that is pointless.

We are all capable of acts of aggression. We need to be aware of that in ourselves. Depression is aggression turned inwards. Should this guy just have been depressed and saved a lot of lives?

When there was a mass shooting of 35 people in Australia in 1996, a massive gun reform action was taken within weeks of the tragedy. There have been less suicides and no mass shootings since. America will never do this – guns are ingrained in our society. The overwhelming majority of perpetrators are male, with their archetypal phallic symbol in hand. The Washington Post reports that agents have not determined if the shooter added mechanical components to a semiautomatic rifle to make it fully automatic…he could have attached a crank that simulates automatic fire, which depresses the trigger faster than the finger and can be purchased online for about $40.

It’s all intellectualization. The fact is that innocent people died. Hundreds are injured, which could mean a lost eye or limb. Thousands will be tragically affected by witnessing what they did last night. Counseling must be started now – immediate psychiatric care has been shown to be crucial in abating symptoms of PTSD. 

While I can write off the shooter as “crazy”, the truth is that mentally ill are more often victims of violence than perpetrators. We will spend months trying to analyze what was going on in his head. 

As a country we should and must grieve for the victims and for us all. The government would like us to stop there. But if too much time passes, people will forget. Nothing will change. I feel there was an undercurrent in the message to the public to respect the deceased and keep quiet. If laws can have an effect on this epidemic of mass shootings, we must do whatever it takes. We must look at a system that works. Let’s ask Australia for advice. 

Object of Desire

On my last trip to Ireland we were in a pub every night for music “sessions”. Reciting poetry for me substituted for musical performance, as I am unable to carry a tune or play an instrument. 

My original poetry is a little over-the-top, borderline erotica. I did do a bit of that. This poem by Kim Addonizio rocked the house.  It was such a hit at the pubs, I had to share it with my loveandmedicine readers.

It is a great expression of the opposing forces that drive women and the reason men love us. 

 

What Do Women Want?

By Kim Addonizio

 

I want a red dress.

I want it flimsy and cheap,

I want it too tight, I want to wear it

until someone tears it off me.

I want it sleeveless and backless,

this dress, so no one has to guess

what’s underneath. I want to walk down

the street past Thrifty’s and the hardware store

with all those keys glittering in the window,

past Mr. and Mrs. Wong selling day-old

donuts in their café, past the Guerra brothers

slinging pigs from the truck and onto the dolly,

hoisting the slick snouts over their shoulders.

I want to walk like I’m the only

woman on earth and I can have my pick.

I want that red dress bad.

I want it to confirm

your worst fears about me,

to show you how little I care about you

or anything except what I want.

When I find it, I’ll pull that garment

from its hanger like I’m choosing a body

to carry me into this world, through

the birth-cries and the love-cries too,

and I’ll wear it like bones, like skin,

it’ll be the goddamned

dress they bury me in.