Randi Hutter Epstein M.D. M.P.H.

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Transforming Our Thinking About Bad, and Even Good, Stress

Many who knew Bruce S. McEwen, Ph.D., either at The Rockefeller University where he ran a laboratory or as a guest at one of his homes in New Jersey or Maine, said the same thing:  For a high-powered New York City-based scientist, McEwen was unusually serene.

But McEwen was deep in stress for more than 50 years.

He conducted pioneering work on stress in the brain in the 1960s and trained a generation of the leaders in the field. I had the privilege of speaking with him a few months ago while exploring the truth behind the old adage about stress hindering fertility.

We had a few fruitful conversations–not  limited to fertility. We chatted stress and its broader impact on health. We talked even talked about the good stress.

Last week, I was devastated to hear that he died after complications from a stroke. McEwen was 81. One of his articles was published on the day he died: January 2, 2020.

In the New York Times obituary that I wrote and that came out today, I touched on his discoveries. His initial study showed that corticosterone, a stress hormone, latched onto the hippocampus, the brain center for learning and memory. This research paved the way for others to show that unrelenting stress causes a spike in stress hormones (cortisol along with other chemical mediators) that shrinks parts of the hippocampus (and swells the amygdala, known for vigilance against a threat).

What drew me to McEwen was, of course, his fascinating research but also that he practiced what he preached. If you were lucky enough to catch a few minutes with him, somehow his approach to life wafted through the room or phone lines, as the case may be. You felt a little more, well, calmer. Perhaps it was his Midwestern mild manner (he grew up in Michigan) compared to my New Yorker neuroses.

Since immersing myself in his research over the past weeks, going over our conversations and listening to his many talks on YouTube, I’ve been reciting a few of his lessons, like mantras. They remind me that a few minutes a day to unwind, to take deep breaths, or to meditate has both immediate and long-term health implications.

  • Reducing stress is good for your brain, right down to the genetic switches.
  • Fleeting stress is a good thing: the kind that energizes you for, say, a talk or test.
  • Stress is not something that happens to you, but the way you respond.

That last one is a tricky one because, in the thick of freaking out about some frustrating incident or a screw-up at work, it’s easy to believe that our racing heart, our shallow breath, our nail-biting infuriation is the right way, or the only way,  to behave. It’s not me. It’s everything done to me. But it’s at those moments, when you realize that the day may be going off course (it may be something you did wrong that needs to be fixed; or something someone did wrong to you), but you can still control your physical responses. You cannot deep breathe away a mishap but you can control the way you allow your thoughts to dwell.

McEwen leaves a massive legacy in neuroscience: he ushered in a new way of thinking about stress. And yet, according to his wide network of friends, students, and colleagues, he also leaves behind another important lesson:

McEwen was kind, supportive, and engaged in life inside and outside his lab. He played tennis, drew, painted, and enjoyed a good glass of red wine with family and friends. He was a dog-person (which ranks high in my books). Students remember his Schnauzer wandering the Rockefeller and sometimes in the faculty club.

Does niceness and companionship help people cope with stress? I would say so. And, in turn, it just may foster better focus and learning. To be sure, avoiding bad stress and engaging in good stress is not a guarantee against every chronic ailment, but it will certainly make the journey more pleasant.McEwen, Bruce S. and Huda Akil, “Revisiting the Stress Concept: Implications for Stress Disorders,” The Journal of Neuroscience, January 2, 2020 40:1 12-21

Here’s a link to his thoughts about good, tolerable and toxic stress.

 

REFERENCE: McEwen, Bruce S. and Huda Akil, “Revisiting the Stress Concept: Implications for Stress Disorders,” The Journal of Neuroscience, January 2, 2020 40:1 12-21

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What is a Full Recovery?

What does it mean to recover fully?

Does it mean the scars aren’t visible? Does it mean you’ve been able to move on with your life? Perhaps a new job or new partner?

Usha Reddi, 54, considered herself recovered after a traumatic childhood. For six years, from the age of 10 to 16, she was sexually abused by her father. She confronted him nearly 40 years after the assaults.

Reddi believed her outward achievements demonstrated her inner strength. She had a successful career as a public school teacher,  served twice as the mayor of Manhattan, Kansas and is currently the City Commissioner and Mayor Pro Tem.  Reddi married, divorced, re-married and is close with her three children and one step-child. As further proof to herself that she was “okay,” she never suffered from addictions to alcohol or drugs.

But the façade of a woman holding it all together started to crack when her children began questioning secrets that they suspected brewed within the extended family—they never saw their grandfather and knew little about him. They also wondered about the impetus behind their mother’s extreme over-protection.

Reddi went public with her story on her local radio station, KMAN, before launching her campaign to run as a Democratic candidate for U.S. Senator from Kansas. And yet, what her story reveals is much more than political savvy, but a woman coming to terms with buried psychological trauma and how digging into her own psyche, however painful, has helped her heal decades later.

“One of the things I’ve done throughout my life is move on and kind of built my own character as I’ve moved on,” she told me. But it was impacting herself in ways she did not want to face and it was affecting her children, too.

Reddi finally decided to tell her daughter and two sons the truth when they were teenagers. Her middle son convinced her to confront her father.

It was a long and painful journey that began with her telling her own children and they convinced her that she needed to bring justice.

“It was a very vulnerable time,” Reddi said.

Her middle son confronted his grandfather and got a taped confession. Reddi was going to report the sexual abuse to the authorities in Ohio, but was stymied because they have a statute of limitations. For a decade nothing happened but her son persisted. He was infuriated that they lived with injustice. Eventually, Reddi learned that she could report  the sexual assault to authorities in Virginia, where there is no statute of limitations and where she lived from the ages of 10 to 12. Her father was extradited from Texas and convicted this summer.

A beloved town doctor, his medical license was revoked and he was sentenced to 10 years in prison with nine years suspended for raping her repeatedly in the 1970s

Like so many children, as a young woman Reddi was terrified that if she sought help, she’d be put in foster care and her father would go to jail. She worried no one would believe her and no one would want to help her.

From her experience as an elementary school teacher, Usha knows that children would rather remain in a family “where it’s horrible than to go the unknown.”

In addition to suffering the physical and emotional consequences of sexual violence, children suffer from the trauma of growing up in a world where the guilty are not punished and the victims feel blamed. Reddi said that what has bothered her the most is that her father was perceived as the victim. “People were saying, ‘don’t do this to him,” said Reddi. “I’m not doing anything to him.”

This whirlwind of emotions brewing deep inside not only destroy trust and hinder social relationships, but recent evidence shows that severe emotional trauma can have long lasting physical damage, including perhaps increased risk of asthma, diabetes and heart disease.

Reddi said she wants to be part of the growing group of survivors who are helping to get the word out to victims of incest or abuse that they need to feel closure, to realize they are the victims, and by doing so will recover power they may have lost. RAINN, the nation’s largest anti-sexual violence organization, provides a list of resources including hotlines, live chats, and therapists.

“This is part of who I am,” she said, “but it’s not everything I am. It’s given me a platform to help other people on this journey. Regardless of what direction they want to go in, they are not alone.”

Furthermore, Reddi wants to expand therapy for families. Her own mother and brother are still angry and blame her for destroying the family. As Reddi said, we have support groups for families of those who battle addictions with drugs or alcohol but we do not have good support groups for families to cope with sexual abuse.

In the August issue of the Journal of Child Sexual Abuse, Agnes Wohl, a clinical social worker and Gregory Kirschen, PhD, a psychotherapist, discuss the impact of using bibliotherapy (turning to fictional age-appropriate stories) along with traditional psychotherapy to help children discuss, grapple, and learn to cope.

Experts say that if a child reveals that he or she has been abused, it’s important to take their stories seriously.

  • Do not fill in words for them.
  • Allow them to tell the story in their own time.
  • Insist it is not their fault.
  • Tell children it is not their fault
  • Let them know they will not be in trouble for reporting.
  • Never say you will keep their secret. You must let them know that you may have to act in ways for their own safety and the safety of other children

For Reddi, the issue was learning to heal not just from the outside (getting a job, learning to trust loved ones) but also healing within.

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A Remedy for Everything

I’m taking a mental health day by avoiding news and immersing myself in medical history. It’s a literary cleanse. I’m reading Sarah Stage’s Female Complaints: Lydia Pinkham and the Business of Women’s Medicine, published by WW. Norton forty years ago, in 1979.

Stage’s book tells the story of Lydia Pinkham’s colossally popular 19th century cure for, well, just about everything. A few sips a day were touted to cure cancer, constipation, menstrual cramps, menopause symptoms, kidney failure and so on and so forth. The target audience was women but men could take it too. The active was alcohol.

Female Complaints delves into the savvy, deceptive marketing.

Remedies that guaranteed cures were all the rage at the turn of the 20th century when lots of people distrusted doctors; when medicine didn’t offer much (this was half a century before antibiotics); when women were embarrassed to talk about female “issues” with their mostly male physicians; when physicians were squeamish to pry into their patients’ womanly complaints.

Not everyone was duped. In the early 1900s, a few muckraking journalists got wind of the false claims such as Lydia Pinkham’s cure and Mrs. Winslow’s Soothing Syrup and wrote a series of articles in Ladies Home Journal. (Mrs. Winslow’s Syrup was a mix of morphine-alcohol touted to cure fussy babies that later became known as a baby killer.) Good for Ladies Home Journal. Other media outlets turned down the pieces because of contracts with drug-makers’ advertisers that stipulated the deal would be cancelled if the publication ran anything detrimental to the products. In those days, according to Professor Stage, some $40 million was spent on these kinds of advertising deals.

In part due to these journalists (but mainly due to Upton Sinclair’s The Jungle, about the horrid conditions in the meat industry), the Pure Food and Drugs Act was passed in June, 1906 and took effect January 1, 1907. (Opponents claimed the law staunched consumer choice.) The Act stated that medicines involved in interstate trade

  1. Meet certain standards of purity
  2. Labels must be truthful
  3. Toxic ingredients must be listed, such as cocaine, opium, morphine, heroin, alcohol, cannibas. (The label need not list all ingredients.)

While doctors and journalists celebrated their victory and pronounced the so-called fake-medicine business dead, hustlers were strategizing. “In the long run the patent medicine manufacturers proved more astute judges of human nature than the reformers,” wrote Stage.

The truth-law only applied to labels so the quack-medicine peddlers promoted their false claims in signs in streetcars; advertisements in newspapers; and mailed pamphlets.

At the same time, the president of the Proprietary Association, the organization of those who sold these so-called patent medicines, issued a seal to anyone who followed the new rules. “Guaranteed Under the Pure Food and Drug Act.” They knew the sticker implied that the product must be safe and effective. In reality, it just meant that the label accurately stated toxins within. The association assumed, perhaps rightly so, that most people would be convinced by the seal of approval and not read the fine print. (The “guarantee system” was halted in 1914.)

The peddlers also hired “testimonial agents,” who procured upbeat blurbs. One broker charged $75 for a senator’s endorsement; $40 for a Congressman. Women were encouraged to write testimonials and were offered free medicine or the cost of a professional photograph. (They were told letters to Mrs. Pinkham would get replies by the maker, herself. Except for one thing, the deal went long into 1890s and early 1900s, years after Pinkham’s death in 1883.)

Sometimes reading about history soothes my soul because 19th century wackiness takes my mind off of 2019 insanity. Back in my grandparents’ day, consumers fell for slick advertising and testimonials. They were lured by claims that preyed on their fears of aging and promises of quick fixes. Can you imagine if people today were just as gullible?

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How To Celebrate The Birth Control Pill’s Birthday

Fifty-nine years ago this week—on May 9th, 1960, the U.S. Food and Drug Administration approved the birth control pill.

The story of the oral contraceptive is unique among hormone histories. It was the first drug prescribed to healthy people for social reasons—a drug that didn’t prevent a disease or even promote wellbeing. It’s the only pill called The Pill. You can’t say that about any other treatment, not even a headache tablet, a vaccine or an operation. That’s what Dr. Carl Djerassi, a pioneering pill researcher, once boasted.

The idea that hormones can be used to prevent conception was based on something doctors and farmers observed for centuries: You can’t get pregnant when you’re pregnant. But it wasn’t until the early twentieth century that an Austrian physiologist explored the notion.

In 1919, Ludwig Haberlandt, a professor of physiology at the University of Innsbruck, wondered if the pregnancy-infertile idea had something to do with the way ovaries change during pregnancy. He transplanted ovaries from pregnant rats into non-pregnant ones. The recipients could not get pregnant.

Twenty years later, in The New York Herald Tribune, William G. Lennox, a neurologist quipped: “An anti-pregnancy hormone which might help solve the growing problem of the overpopulation of the unfit.” (It was considered one way to promote this controversial notion of preventing conception.)

The history of the pill includes maverick scientists—some traipsing through the forests in Mexico for a plant that made an estrogen-like substance. It also includes feminists pushing for a hormone-based contraceptive when even the mention of birth control was considered obscene—not the news fit for print. Jonathan Eig, recounts the story in The Birth of The Pill: How Four Crusaders Reinvented Sex and Launched a Revolution, a page-turner tale for anyone who wants to dig into the history and get to know the personalities behind the discovery and dissemination.

When the FDA green-lit the first pill in 1960, the process was seen as a triumph of science and society, working together for a medical advance. Compared to all the other medical discoveries, hormones had seemed safer. They weren’t made from germs the way antibiotics and vaccines were. They weren’t toxins like many cancer drugs. They mimicked human chemistry. They were a seemingly natural remedy to control the most natural event of all—making babies.

By the 1970s, more than 6.5 million women were on it.

But the birth control pill came to symbolize a turning point in our relationship to hormone therapies. Fears mounted that this hormone contraceptive, in the doses delivered, was triggering headaches, bloating, and also life-threatening blood clots.

Today the pill comes in much lower doses than the original form. We also have package inserts that list all the potential side effects. This is, in part, thanks to such as Barbara Seaman, who wrote The Doctor’s Case Against the Pill, and Alice Wolfson, now a lawyer in San Francisco, who as a 29-year-old interrupted the 1970 Senate hearings to demand that women’s voices be heard.

Yet, despite these huge advances, we could do better. There are still women who feel depressed on the pill. Others who suffer from life-threatening blood clots. Too many women are denied access to affordable contraception. The 59th birthday of the birth control pill should be a time not just to consider the scientific and political feats that made this all possible, but to think deeply about where we are today and what we need to make contraception safer and available for all women who need it.

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When a Scar Tells a Deeper Story

This happened to me twice when I was reading The Scar, Mary Cregan’s engrossing memoir.

A friend came by to say “hi” and, each time, I nearly jumped out of my seat. I was, both times, in a bustling café and so absorbed in the writing that I forgot where I was until the sound of my name jolted me back to reality and my drink nearly went flying.

A writer-friend calls that kind of immersion a “fictional dream.” It’s when the words chauffeur you into the author’s imaginary world.

The Scar is non-fiction but it pulls you in all the same. Cregan writes about her spiral into suicidal depression that began after her daughter’s death.

Anna was born on a Sunday morning in 1983. The Apgar score (a quick assessment of a newborn’s overall health) was low. Anna’s body temperature didn’t return to normal after her first bath. When the nurse held her, the frail infant legs dangled limply.

A doctor came by and Cregan recalled that he said “he feared a heart problem, and in his cautious manner of speaking made it clear that whatever was wrong was very, very bad. He delivered the news and left the room as quickly as he could, but grief broke from us in strange animal sounds before he could close the door. Everything went sliding sideways in that moment, as if reality were breaking up, splitting into dangerous, unrecognizable shards.”

Anna had a fatal heart defect. She died within days of her birth. The Scar takes us along on Cregan’s journey during the aftermath of the baby’s death: Cregan’s hospitalization, attempted suicide; and her treatments that included electroshock therapy, drugs and talk therapy. She even reveals bits written about her from the doctor’s medical records.

Despite the horrific circumstances, there’s little self-pity. It’s as if she’s staring at her younger self, like a medical detective, trying to make sense of it all. Why couldn’t she grieve and move on? Was it brain chemistry gone awry? Some kind of vulnerable genes inherited from her family?

Cregan’s focus is tight and vivid as she describes her own crises, her hospitalizations and path to recovery. But amidst her personal story, she opens the aperture to discuss the science and history of each therapy; the broader implications of treatments.

The earliest seeds for electroshock therapy, for instance, date back to the 18th century. Dr. John Birch, a surgeon in St. Thomas’s Hospital worked in the so-called medical electricity department. In 1792, he applied electricity to the heads of two inpatients suffering from melancholia. One man, he reported, became “cheerful;” the other “refreshed.”

Benjamin Franklin toyed with electricity as a way to help those with severe melancholia but he wasn’t as convinced with its potential.

Cregan contemplates the reasons electricity is considered horrific in psychiatry but accepted in other fields of medicine. (She devotes a chapter to One Flew Over the Cuckoo’s Nest and the decline in ECT shortly thereafter.)

“It is curious,” she writes, “that ECT provokes such horror while television shows like ER and Grey’s Anatomy routinely feature the dramatic effect of electricity when applied to a heart in cardiac arrest.”

The Scar is a heart wrenching, smart read that sheds a light on a dark subject.

Cregan, who has a PhD in English from Columbia University and currently teaches at Barnard, sprinkles the book with literary references and lines of poetry. It offers the reader a chance to perceive mental illness from another prism.

Those who have experienced the kind of emotional trauma that Cregan describes—some 15 million Americans have had at least one bout with major depression—will find company in her memoir, solace in her words. The rest of us can learn not only about her story but how many psychiatric drugs and treatments came to be.

“The story of my scar isn’t heroic, but no less than the hero Odysseus,” Cregan writes, “I am a survivor. In the much older body of the desperate young women who tried to end her life with a piece of broken glass, I am still here.”