Symbolism Versus Substance

Chris Weigant


The House of Representatives, as expected, just voted to repeal the landmark healthcare law, which President Obama signed less than a year ago. This vote was a symbolic victory for Republicans, but not any sort of substantial change. To truly repeal the law, the Senate would have to also pass the bill the House just passed, and then both houses would have to muster a two-thirds majority vote to overcome Obama’s veto. None of which is going to happen. Democrats still control the Senate, and Harry Reid has all but pronounced the bill “dead on arrival” in his chamber, meaning that today’s House vote is the only victory (and a symbolic one, at that) Republicans should expect in their mad dash to repeal healthcare reform.

Which is probably fine with them. House Republicans know full well that their vote today is nothing more than empty symbolism — but it is important empty symbolism, as far as they’re concerned. The Tea Party Republicans who campaigned on the issue of “Repeal!” have proven their bona fides to their fervent supporters, and now they can throw up their hands and blame the expected inaction on Senate Democrats — thus paying no real political price for spending time on such a Pyrrhic victory. In other words, Republicans in the House have won a single “news cycle” — even though the more honest among them fully admit that the effort is ultimately going nowhere.

The entire exercise is nothing more than “politics for politics’ sake,” really. Which is fine — both political parties do this sort of thing at times, to toss some symbolic red meat to their base. And as political red meat goes, this was the juiciest symbolism Republicans had at their disposal. The last time Republicans engaged in such potent symbolism was when Newt Gingrich took control of the House, and quickly passed all the items on his “Contract With America” — only to see virtually all of the bills screech to a halt in the Senate.

Republicans can bask in this symbolic victory, but when Congress really gets down to business (after next week’s State of the Union speech by President Obama), things are going to get a bit more complicated. The campaign slogan many of these Republicans ran on (in relation to what they called “Obamacare”) was “Repeal and replace.” In other words, throw the whole thing out and then start over and replace it with the wonderfulness of the Republican plan on healthcare reform. The only problem with this scenario (other than the fact that repeal isn’t going anywhere after the bill leaves the House) is that there is no “Republican plan on healthcare.” It doesn’t exist.

This is where the substance comes into things, after the symbolism becomes yesterday’s news. Republicans aren’t just going to pat themselves on the back for their symbolic repeal vote and then move on to other things — they’re going to try to tinker with healthcare all year long, apparently. This action will happen on several fronts. The first of these is using Congress’ traditional “power of the purse” to starve “Obamacare” of the funds it needs. Republicans may try to write into the Health and Human Services budget a ban on using one thin dime to implement the healthcare reform law passed last year. This will likely result in only symbolic victories, since (again) the Senate is going to have its say on the budget, and since many of the provisions of the healthcare reform law aren’t actual budget issues and thus can’t be gotten rid of with the blunt instrument of Congress de-funding them.

The next effort is going to happen (if it does) when Republicans mull over exactly how they want to tinker with the existing law in various House committees. This is where they’re going to have to admit (implicitly, at least) that some of the provisions of the new law are actually quite popular with the public. Now that they’ve made their symbolic point with today’s repeal vote, Republicans will be able to tell Tea Party voters: “We tried to get rid of the whole thing, but now we’re going to have to change it piecemeal.” Conveniently, the pieces that the public likes the most will likely escape such efforts to rewrite the law. About the biggest change that could actually make it through Congress might be getting rid of the individual mandate — which has few defenders, even among Democrats.

Other than repealing the mandate, however, things get complicated awfully fast. It wouldn’t surprise me to see Republicans struggle with exactly what to do on healthcare for months. There’s a reason Democrats took more than a year to hammer something out, and the reason is that there simply aren’t easy answers to the problems in the system. So Republicans are going to spend an awful lot of time figuring out which tactic to try in their overall efforts to get rid of “Obamacare.”

It remains to be seen what the public is going to think about this effort. Polling is pretty evenly split on the Democratic healthcare reform, and it’s probably a safe bet to say that polling will likely be all over the map on the ideas Republicans come up with. But the overarching question will likely not even be asked by the pollsters — at what point does the public begin to wish that Republicans end their “Obamacare” obsession, and get on with some other important business? After all, we’ve spent a goodly portion of the past two years on the healthcare reform debate, and if Republicans decide to devote a lot of time to rehashing the issue for the next two years, at some point the public is going to get a little tired of hearing about the subject (if they’re not already).

This week in the House was set aside for symbolism. The Republicans achieved the symbolic victory they had planned today. Which is all fine and good — as I said, both parties occasionally delve into such blatant political gamesmanship. Congress traditionally doesn’t get much done in January anyway, other than getting sworn in and listening to the State of the Union speech. And now Republicans have their symbolism to talk about next week, after Obama speaks to a joint session of Congress and the country at large. But that will be the only tangible result of today’s action in the House — a talking point for Republicans to use for a while.

In one sense, this week will mark the end of Republicans’ political coyness and over-reliance on symbolism. Because after the president’s speech, they’re going to have to actually put some cards on the table. Substantive cards — not mere symbolism. Republicans are going to have to finally tell the public how exactly they’re going to be cutting spending from the federal budget, instead of blithely insisting that they’ll find enough “waste, fraud, and abuse” to balance the budget in a year or so. They’re going to have to start coming up with actual legislative ideas on the budget, and on healthcare reform, and on a number of other subjects and issues. Up until now, it has been “campaign season,” where politicians can get away with gauzy promises without answering any questions about specifics. This week marks the end of this happy-talk season, and the beginning of the “nuts-and-bolts” season of writing their campaign promises into actual legislation.

So Republicans should enjoy their symbolic moment in the sunshine. It certainly is fun to pass a bill that everyone knows isn’t going any further. But the time for such symbolism is fast drawing to a close. And the substance that follows is not going to be anywhere near as much fun for the Republicans, as they will be forced to present concrete proposals to the public on how to solve the nation’s problems. Republicans should indeed enjoy their symbolic holiday while they can, because what comes next is going to be a lot more real than tossing symbolic red meat to their base.

Web Source: http://www.huffingtonpost.com/chris-weigant/symbolism-versus-substanc_b_811363.html#

Long-Term Antidepressant Treatment Contributes To Significant Increases In Weight Gain And Obesity

On January 18, 2011, in Depression, Medication, by Christopher Fisher, PhD


This study demonstrates that patients using antidepressant medication continuously, mostly serotonin-selective reuptake inhibitors (SSRIs), show significantly more (abdominal) overweight and obesity than those using them intermittently or not at all. Compared with SSRIs, other types of antidepressant medication used (e.g. tricyclic ADs) did not have a significant impact on the anthropometric measures (i.e., measurement of of human physical variations).

In a study published in the last 2010 issue of Psychotherapy and Psychosomatics, a group of researchers of the University of Amsterdam presents new findings on the relationship between weight and recurrent depression.

The literature on the relation between obesity and the recurrent type of major depressive disorder (MDD-R; having had at least 2 major depressive episodes) is limited and equivocal. Most studies on depression and obesity did not distinguish between single and recurrent episodes. However, this distinction may be important because depression is increasingly considered a chronic recurrent disorder with various levels of interepisodic functioning, and evidence is growing that the recurrent type is a distinct one.

Most studies on the relation between depression and obesity did not control for antidepressant (AD) medication use, although a substantial part (20 – 60%) of the recurrently depressed patients use ADs for lengthy periods of time. This study elaborates on their findings by focusing on the relation between obesity and MDD-R and the association between long-term use of ADs and obesity.

To be eligible for this study, patients had to meet the following criteria: (a) at least 2 major depressive episodes in the past 5 years (DSM IV), (b) current remission status, according to DSM-IV criteria, for longer than 10 weeks and no longer than 2 years before, and (c) Hamilton Rating Scale for Depression of <10.

At 2 years, follow-up assessment anthropomorphic parameters were collected of 134 subjects.

To assess relapse/recurrence, the Structured Clinical Interview for DSM-IV (SCID-I) was used. Regarding the use of ADs, two groups were distinguished: those who used Ads throughout the entire 2-year study period (n = 46) and those who did not use ADs continuously, but intermittently (n = 49) or not at all (n = 39). Differences between these groups in BMI, waist circumference, and waist-to-hip ratio were tested stratified by gender.

Overweight and obesity occurred more often in patients with recurrent depression than in the reference group, although statistical significance was reached in women only (74% of this sample). Within the MDD-R patient group, serotonin-selective reuptake inhibitors (SSRIs) were the most commonly used type of AD among the continuous AD users. Compared with SSRIs, other types of ADs used (e.g. tricyclic ADs) did not have a significant impact on the anthropometric measures.

The mean AD equivalent correlated positively with both waist circumference (p = 0.006) and waist-to-hip ratio (p = 0.004), but not with BMI. In addition, mean waist circumference and waist-to-hip ratio scores were consistently higher amongst the continuous AD users compared to intermittent and no AD users. Patients using ADs continuously, mostly SSRIs, show significantly more (abdominal) overweight and obesity than those using them intermittently or not at all. Compared with SSRIs, other types of ADs used (e.g. tricyclic ADs) did not have a significant impact on the anthropometric measures. The authors did find, however, a small association between AD equivalent dosage and waist circumference and waist-to-hip ratio.

In general, a better understanding of the relationship between obesity and depression that includes understanding the beneficial and adverse effect of psychotropics on appetite, eating behaviour, body weight, and metabolism should improve our ability to prevent and treat both obesity and depression. Thereby, ideally persontailored interventions can be developed, including effective nonpharmaceutical preventive strategies for recurrent depression and extra physical activities with – as added benefit – protection against AD-induced weight gain.

Material adapted from Journal of Psychotherapy and Psychosomatics.

Reference
Lok, A.; Visscher, T.L.S.; Koeter, M.W.J.; Assies, J.; Bockting, C.L.H. ; Verschuren, W.M.M. ; Gill, A. ; Schene, A.H. The ‘Weight’ of Recurrent Depression: A Comparison between Individuals with Recurrent Depression and the General Population and the Influence of Antidepressants. Psychother Psychosom 2010;79:386-388.

Web Source: http://www.bmedreport.com/archives/22150?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+TheBehavioralMedicineReport+(The+Behavioral+Medicine+Report)

UNC Researchers Investigate Estrogen Replacement Therapy To Prevent Depression And Cardiovascular Disease

Article Date: 13 Jan 2011 – 2:00 PST


Researchers at the University of North Carolina at Chapel Hill have launched a new clinical trial to determine if estrogen replacement therapy may help prevent depression and cardiovascular illness in women between the ages of 45 and 55.

It’s a move that may raise eyebrows in some quarters, given that a Women’s Health Initiative (WHI) study was halted in 2004 due to findings that estrogen therapy resulted in an increased risk of stroke and blood clots.

But there’s an important difference between the UNC study and the WHI estrogen study, said David Rubinow, MD, UNC’s chair of psychiatry and one of two principal investigators of the new 5-year study, which is funded by a $4.5 million grant from the National Institutes of Health. The other principal investigator is Susan Girdler, PhD, professor of psychiatry.

“The Women’s Health Initiative study led to the mistaken belief that estrogen replacement therapy is bad for all women. And as a result, it has served to deprive some women of a treatment that might greatly and favorably impact their lives. Much of the negative impact of estrogen that they found was related to the fact that most of the women in the Women’s Health Initiative study were far past the menopause and up to 79 years old,” Dr. Rubinow said.

“There are now a large number of studies that demonstrate what has been called the timing hypothesis. That is, giving estrogen within a year or two of menopause has beneficial effects, but giving estrogen in women more than five years beyond the menopause can actually be harmful.

“When the women who were close to menopause were looked at separately, the adverse effects on the heart were not seen and in fact some suggestion of beneficial effects was seen. Perimenopausal women in the Women’s Health Initiative who received estrogen had significantly lower coronary artery calcification compared to the women who didn’t take estrogen.

“That raises the question: Is estrogen potentially beneficial for women in the perimenopause – the years surrounding the menopause? It’s really an unanswered question at this point. Our study is an effort to find out what puts an individual woman at risk for heart disease and depression and what predicts beneficial effects of estrogen replacement during the perimenopause on affective well-being and cardiovascular well-being.”

The study, which began in August 2010 and will be conducted entirely at UNC, seeks to enroll a total of 320 women ages 45 to 55 who are in the menopause transition. All will be randomized to receive treatment with estradiol (estrogen replacement) skin patches or placebo.

Women in the study will be tested three times: before treatment and then again after 6 months and 12 months of treatment. These laboratory tests will measure their cardiovascular and inflammatory responses to mental stress, indicators of cardiovascular health and metabolic markers such as a glucose tolerance test, waist/hip ratio and lipid profiles. In addition, assessments of their moods, vital signs, side effects and compliance with the treatment regimen will be conducted on each participant

“Given the mortality and morbidity associated with depression and heart disease, and the tremendous increase in risk of these disorders during the perimenopause, it is critical that we identify those women who will be helped by estradiol,” Dr. Rubinow said.

The research study is currently enrolling participants. Eligible women will receive free study related medical evaluations and up to $1,200 in monetary compensation for completing all study visits.

Source:
University of North Carolina at Chapel Hill School of Medicine

View drug information on Estradiol Transdermal System.

Research May Yield New Drug Targets for Memory, Anxiety Disorders

By TRACI PEDERSEN Associate News Editor
Reviewed by John M. Grohol, Psy.D. on January 10, 2011


A new drug target for anxiety disorders — and particularly post-traumatic stress disorder (PTSD) — is now possible due to a recent unexpected discovery by UCLA scientists.  Their research has honed in on neuronal gap junctions — channels in which electrical communication occurs between inhibitory neurons. 

The discovery also holds promise for Alzheimer’s disease and other memory-related disorders.

“The brain has many processes we have not yet explored,” said UCLA Professor of Psychology Dr. Michael Fanselow. ”Understanding them and how they normally work can open up new approaches that may help in very prevalent and debilitating diseases, such as anxiety disorders and memory disorders.”

Gap junctions form where inhibitory neurons touch one another. They are an opening between nerve cells that allow electrical activity to pass from one neuron to another.

When an individual has a terrifying experience, there is often a lingering fear of the place where it happened. This occurs because the nerve cells in certain brain regions increase their ability to excite or stimulate one another, said Fanselow, leader of the study and member of UCLA’s Brain Research Institute.

So far, most studies have emphasized that this experience happens because of the communication among neurotransmitters moving across synapses (spaces between neurons). However, there is also direct electrical contact among other small, inhibitory neurons in these areas as well, and these connect through gap junctions, Fanselow said.

“I was completely surprised by this discovery,” he added. “I really thought we were taking a long shot and was surprised that gap junctions were not only playing a role but that their importance was so great.”

Interestingly, these gap junctions are very common in invertebrates but rare in mammals, where they can only be found on certain inhibitory interneurons.

“Because of this, no one has looked at the importance of these gap junctions for learning, memory and emotion,” Fanselow said. “We hypothesized that these gap junctions may be very important. Because the gap junctions cause the inhibitory neurons to fire together, they may cause these inhibitory neurons to act as a pacemaker for the excitatory neurons, making them fire at the same time so they are better able to make fear memories.”

The study included the use of several drugs that block gap junctions in rats, and it was discovered that because the medications disrupted vital rhythms in the dorsal hippocampus (a brain region most associated with cognition), they were able to keep any “fear of place” memories from forming.

The drug injections worked when given right after a frightening experience, revealing that they could be particularly useful for PTSD.  Also, the drugs were just as effective when regularly injected into a cavity near the abdomen as when put directly into the brain.

“Because we don’t know when a person will experience trauma, treatments that can work after the experience hold more promise,” Fanselow said.

“Our research shows a way that neurons can coordinate their activity, and this coordination is critical for memory formation,” Fanselow said. “Perhaps if we had a way of enhancing gap junction function, we may improve memory formation by facilitating gap junctions when memory is impaired by diseases such as Alzheimer’s. However, we have not shown this yet.”

Fanselow noted that the formation of fear memories is what drives anxiety disorders, which are quite common and can be very debilitating. “Gap junctions appear to be key in coordinating the activity of the network of neurons that produce fear memories, specifically, and probably other memories, generally, as well,” he said.

Source:  University of California

Source Site: http://psychcentral.com/news/2011/01/10/research-may-yield-new-drug-targets-for-memory-anxiety-disorders/22437.html

The Year of Living Anxiously

by Henry Emmons, M.D.

The Anxiety Resolutions


There are sure-fire ways to make yourself anxious, if you wanted to do so. No one would do this on purpose, yet without knowing it that is exactly what many of us do every day. How do we do it? Here’s my list of some of the most common mistakes that aggravate the condition we call anxiety. But first I’d like to comment on stress.

In my opinion, stress has gotten a bad rap. Life is stressful, and always has been. Yet when we feel like ourselves, we are naturally resilient. We adapt to stresses remarkably well, often finding ourselves stronger or more skilled by having confronted life’s unavoidable challenges.

Stress alone is not the problem. Instead, we become our own enemy. The common mistakes that follow will reliably turn everyday stress into overwhelming anxiety:

1.) Keep thinking about what is wrong.
Neuroscience has confirmed what we already know: when we replay worrying thoughts again and again, we strengthen the neural pathways for those thoughts, so that they become ingrained in our mind like bad habits. It is as if we are rehearsing worry and anxiety. As with anything, we get better and better at it with practice.

2.) Keep talking about what is wrong.
Pop psychology has given us the notion that it is good to express our feelings. That can be true, but many of us take that to mean that we should “vent”. If someone is willing to listen, we often share our stories of woe. Repeated unloading keeps our anxious feelings alive and may even strengthen them.


3.) Over-stimulate yourself.
Caffeine, tobacco, loud noise, driving fast, working without breaks, skipping meals-there are so many ways to keep the body and brain on overdrive and keep the anxiety levels high.

4.) Don’t allow for time to refresh and renew.
After a stressful experience, it is normal and healthy to take time to rest and recover. That lets the body’s stress response system calm down, reset and get prepared for the next challenge. Our ancestors ran and then they rested; we stay on the treadmill. Not allowing for downtime differentiates our response to stress from every other time in human history.

5.) Stay constantly busy.
This is a variation on the last point. It is not only during the stressful times in life that we overdo. Most of us do too much every single day. You may have heard the phrase: “We are human beings, not human doings.” We are simply not designed to be on the go 24/7.

6.) Give in to your cravings.
Most of us reach reflexively, without thinking, without deciding, for something to soothe ourselves when we feel stressed or anxious. We often eat comfort food like sweets or other food laden with carbs and fats. Whatever we crave, we crave it because it makes us feel better-for much too short a time. Unfortunately, the comfort is brief and we almost always end up feeling worse in the long run.

7.) Short-change your sleep.


If there were a single sure-fire way to break a person down, it would have to be too little sleep. Lack of sleep is an accelerator toward most mental illness, and anxiety is no exception. Getting an average of 7-8 hours per night is not only helpful, it is essential.

8.) Stay sedentary.
Think about what happens in nature: the “fight or flight” reaction means that stress hormones flood the body, priming it for some kind of physical action. Sitting most of the day means the stress hormones have nothing to do but re-circulate. Moving your body helps to discharge the effects of all of those stress hormones and reset yourself back to a normal resting state.

9.) Isolate yourself.
It is a wonder that so many have become isolated and alone when we are clearly wired to connect. As the Dalai Lama has said, “We can live without religion and meditation, but we cannot survive without human affection.” Meaningful connection doesn’t solve everything, but it goes a very long way toward helping us endure the difficult side of life.

10.) Believe that you’re in it on your own.
The spiritual traditions give us a consistently reassuring message: “All will be well.” But when our brains get locked into anxious patterns, we can’t believe that. We see our small, individual selves as being solely responsible for our lives without any support. It is an illusion. If we can see through it, we can tap into a deep well of reassurance and hope.

11.) Watch the news daily.
You’ve heard that we are what we eat. We may also be what we take in through our eyes and ears. A study in Scandinavia showed that watching the evening news, filled with stories of tragedy, violence or other bad news, had a strong effect on rates of anxiety and depression. Does that mean that we should keep our head in the sand? No, but it may be wise to pay attention to what we are feeding ourselves through our minds, especially when we are going through personally hard times.

12.) Play video games.
It should come as no surprise that a game that simulates trauma and violence would put the brain into a state that is similar to the real thing. Researchers have found that common video games do just that. They may even create lasting brain changes so that things don’t go right back to normal when the game is done. The news is not all bad for video games, though. Soldiers in Iraq who played an absorbing game like Tetrus shortly after witnessing a trauma were able to protect themselves from developing post-traumatic stress symptoms.

13.) Become addicted to stress.
Some people appear to thrive on stress. They choose to remain overly committed, or constantly create high drama in their lives, and they seem to do fine. But if the stress stops, things begin to crumble. It is as if they have become addicted to stress and the high level of stress hormones that flood their body. Take the stress away, and they go into a form of withdrawal. Since no one can remain stressed forever without consequences, they should heed the warning signs and get a handle on their stress level.

We would do well to avoid what we can of the above pitfalls, but we won’t do it perfectly any more than we can keep all of our resolutions to do the right things. If we are in the game of life, stress cannot be avoided. That is all the more reason to become better at dealing with it.