illustration by michael jacobsen
While we often think of health and wellness through the prism of crisis or acute disease, we’ve focused this feature on the management of ongoing health concerns, as they are often both more widespread and less likely to be properly treated. These issues—which arise most commonly in the form of anxiety, chronic pain, chemical dependence, and stress—are of special concern to women, who make the primary health care decisions in two-thirds of American households, but they also affect the lives of millions of men, a group that doesn’t seek help as frequently. Fortunately for all of us, health-care professionals all over Minnesota are helping patients find new ways of coping with some of the chronic risks of contemporary life.
In this article:
The Edge of Dread: Anxiety
Anxiety is today’s most common mental-health issue.
illustration by michael jacobsen
A certain amount of fear is wired into us for our own safety—the instinct to avoid a wild animal, or not to touch a burning flame. But for one Twin Cities anxiety sufferer, her sense of peril made it a struggle to function in everyday life. “I thought if I touched a doorknob, I would get AIDS,” she says. “And while I knew this was irrational, I couldn’t make the fear go away.”
Another local sufferer describes a trip to the Grand Canyon, when he found himself paralyzed with fear, as though he was clinging to a perilous ledge, when in fact he was on a wide and well-traveled hiking path. “It felt like my body was going to pull itself over the edge, like it was inevitable,” he says. “I was frozen for 15 minutes, trying to will myself to go forward and unable to go backward.”
While fear and stress are normal responses to external events and circumstances, anxiety is a pervasive dread that isn’t tethered to immediate reality. As Minneapolis therapist and clinical
social worker James Stolz explains, “Fear keeps you safe. Anxiety keeps you stuck.” Anxiety disorders affect more than 40 million Americans (18% of the adult population), and only about a third of that number seek out treatment.
“As a society, we’ve come to accept a level of anxiety that’s unhealthy,” says Stolz. “We’re told we’re supposed to be able to multitask, we’re constantly bombarded by competing stimuli, and we eat anxiety-producing diets that are high in sugar, processed carbs, and caffeine.”
Twin Cities psychologist Chris Donahue says it’s important to seek treatment when you find anxiety limiting your choices—your ability to go to a mall, attend a work event, or even leave the house—or when loved ones observe that it’s getting in your way. Risk factors for developing an anxiety disorder include genetics, brain chemistry, stressful life circumstances, and personality.
Anxiety-disorder sufferers tend to see the world as a web of interconnected concerns, which can lead to overthinking the ramifications of each choice. While women far outnumber men in lifetime rates of anxiety disorders, both Stolz and Donahue suggest that men may be under-diagnosed when it comes to anxiety, which, especially in the case of obsessive-compulsive disorder, often involves a certain level of secretiveness and private, ritualized behavior.
The primary treatment for anxiety disorders is usually cognitive behavioral therapy—which focuses on the relationships between thoughts, emotions, and behaviors—in combination with medications. Stolz has moved away from pharmaceuticals as a primary tool for treating his clients’ anxiety, stressing instead the importance of exercise, meditation, and diet. “There are ways of eating that are pro- and anti-anxiety,” he says. “Someone with anxiety should avoid foods like caffeine and sugar, whose effects mimic the symptoms of anxiety.” He also cites research that suggests that pre- and probiotics may have beneficial effects on mental health.
Donahue notes that there is still a place for medication in severe cases. “If the biology of the disease is out of control, individuals can’t even approach the therapy,” he says. “For some folks, medication might give them a bit of an edge in order to be able to [participate in] the therapy.”
Stolz also points out that a degree of anxiety can be a good thing. “Sometimes anxiety can be a sign that we’re doing something right,” he explains. “Following your passion, plunging into the unknown—these things are going to produce some anxiety. Worrying about the future makes you do something about it in the present. From that perspective, anxiety is helpful.”
Full Stop: Addiction
New science and holistic perspectives are improving addiction treatment.
photo by tj turner
Understanding addiction has come a long way since the 1880s, when Sigmund Freud proclaimed cocaine the ideal treatment for alcoholism; as recently as the 1950s, alcoholics were relegated to state-run asylums. But chemical dependence maintains a stubborn hold on contemporary life: In 2013, approximately 8 percent of Americans were classified with substance dependence or abuse, with millions more family members and loved ones directly affected.
One of the most insidious effects of chemical dependence is how it masks its own presence. “Ninety percent of people with a substance dependency don’t seek treatment because they don’t realize they have a problem,” says Dr. Marvin Seppala, chief medical officer at the Hazelden Betty Ford Foundation. “That’s part of the nature of the disease.” Seppala adds that drug and alcohol abuse appear to change drives in the brain—to the point at which continued use trumps even the drive for survival, leading to profoundly destructive behaviors.
As one recovering addict explains, “It hijacks your brain; wild horses couldn’t keep you from getting your fix,” she says. “You can never be present in the moment because you’re constantly planning how and when you’re going to get that next fix of the thing you need.”
Hazelden was among those institutions that developed in the early 1950s what is called the Minnesota Model—a loose term for an approach that combines professional support with counseling from fellow recovering addicts. While in the past an individual might be treated for acute withdrawal symptoms and released, today it’s understood that addiction requires the same level of continued professional intervention as other chronic and life-threatening diseases.
Opium, cocaine, heroin, crack, and methamphetamine have all taken their turn as the most widely abused drug of the day in the U.S. Today, the leader is opioids, including heroin, morphine, and, most crucially, prescription painkillers, which have resulted in 175,000 overdose deaths in the past decade. Since 2007, deaths from prescription painkillers have outnumbered those from cocaine and heroin combined.
“What’s new and disturbing is the number of young people dying,” says Seppala. “Ten years ago, that wasn’t a regular part of my job. Now, a high school senior is prescribed a painkiller after injuring his shoulder during a football game, and a few years later—boom—he’s dead of an opioid overdose.”
Paradoxically, pharmaceuticals also hold the key to some of the most promising treatment. “The main issue is the over-prescribing of opioids for chronic, as well as mild to moderate, pain,” Seppala says. “Within the next few years we should have more options [for pain treatment], which will help limit the likelihood of addiction across the country.”
Meanwhile, advances in neuroscience are leading to the development of new medications that researchers hope will help addicts break their substance dependence. Medications such as anabuse and methadone have long been used to treat alcoholism and opioid addiction, and new research hopes to find drugs to combat dependence on stimulants such as cocaine.
Seppala adds that other developments, such as improved recognition of mental-health issues that compound addiction (depression, trauma, and anxiety), are reason for optimism, as well as the increasing understanding and integration of spiritual practices such as meditation and positive psychology into mainstream medicine.
“We’ve been looking at healing from a spiritual perspective in the field of addiction all along,” says Seppala. “Now scientists are documenting the positive effects of love, joy, and human interaction in a way that will advance a lot of human ills, particularly addiction.”
When an addiction is finally overcome, that person’s life can be profoundly transformed. “Every day is a gift,” explains a former addict now 13 years sober. “Recovering addicts are grateful because we spend the rest of our days with the sense of having experienced a miracle.”
Pain Reliever: Chronic Pain
A Twin Cities doctor who treats chronic pain also suffers from his patients’ plight.
Dr. Todd Hess is medical director of the United Pain Clinic, a St. Paul outpatient clinic specializing in chronic-pain treatment. As a sufferer from psoriatic and spinal arthritis, Hess has a unique insight into patients’ needs while managing the physical symptoms and psychological struggles that come with chronic conditions.
“When I trained at Mayo Clinic as an anesthesiologist, I met some patients whose pain was going untreated, and I thought Why aren’t these people being listened to? I left Mayo and came to the Twin Cities to build a pain-management program. It was a new field in the late ’80s. I wanted to build an inclusive program that integrated holistic practices like acupuncture, biofeedback, and yoga—which was considered really freaky back then. I experienced quite a bit of pushback from some established doctors, but I had good support from United Hospital.”
“I went into medicine because I want to help people (which is what everyone puts on their med school application). But when I got sick, it changed everything. Now I really get it, and it’s personal. It’s not something I want, but it grabbed my soul and shocked me.”
“I had done everything right: no drugs, no drinking, I followed a vegetarian diet for years, I exercised. I thought, How did this happen? I went into a funk. I’m an upbeat and positive person, but all of a sudden I was facing depression and suicidal thoughts. I was thinking, How am I going to live with this? I don’t think I can.”
“The key is to always be hopeful, be positive, and remember we’re holding out for a cure. There are still days when I get up and think, I can’t do this any longer. But there’s always something you can do to improve pain, even if you can’t make it go away completely.”
“Opioids are one part of the puzzle. Some patients do wonderfully on them, and some do not. They’ve been used inappropriately in many cases, and demonized because of that, but with the right safeguards they can be very useful. We use a thorough safety care plan, including pill counts and psychological assessments, to make sure patients use them appropriately.”
“I’m hopeful that we’ll find a non-narcotic way of blocking pain. A lot of stem-cellresearch is promising in terms of finding the genetic and neurological roots of pain. We’re learning more about neurochemistry and how pain works on nerve receptors. We have studies showing that acupuncture does help. There’s research on the positive effects of exercise, and of swearing! [Laughing] I want to make a soundproof cursing room at UPC, and encourage patients to let it all out.”
“I get weekly injections of a biologic drug that has been a miracle for me. I still have pain and joint disease, but after starting the injections, I was able to run again. It brought my pain from an eight [out of 10] to between three and seven, depending on the weather and other factors. There’s no easy way to live with pain, and no one thing that will make it go away. It really takes a combination of diet, exercise, mind-body work, medications, injections, and psychological support.”
“Sometimes I feel like I’m more of a life coach than a doctor. When one of my fibromyalgia patients finishes a marathon, I’m there bawling at the finish line. For so many people, [chronic pain] devastates them and leads to suicide. For others, it draws them to self-actualize—to lose 100 pounds and accomplish something great. With humor, energy, and caring, you can help someone do that.”
“A cure is coming, but like a kid at Christmas, it’s never coming fast enough. I would do anything to get rid of my pain, but I don’t have a choice. You grab the bull by the horns and ride it. And it is a bull. The Pain Center is a place of learning to live again. We have to rebuild our lives, and that’s what we’re trying to do.”
Photo by TJ Turner
Tips for Easing Life’s Pressures
illustration by michael jacobsen
Americans across the board report money, work, family responsibilities, and health top the list of major concerns that contribute to overall feelings of stress and pressure, with women experiencing the highest levels. The good news? First: Overall reported levels of stress decline with age. Next: There’s plenty you can do today to reduce feelings of stress in your life.
Exercise Physical exercise is one of the most effective ways of addressing stress—at any age, and at any fitness level. Getting moving raises production of endorphins (the brain’s natural chemical feel-good cocktail), raising mood and enabling you to let go of tension through focusing on activity unrelated to everyday preoccupations. You don’t need to be a triathlete—the Mayo Clinic recommends building up your fitness levels gradually and picking an activity you find enjoyable.
Prioritize The National Institute of Mental Health recommends managing what’s causing us stress: “Decide what must get done and what can wait, and learn to say no to new tasks if they are putting you into overload. Note what you have accomplished at the end of the day, not what you have been unable to do.”
Practice Meditation Forms of meditation, yoga, and tai chi have all been found to lower blood pressure and relieve stress. Organizations such as Mindroads Meditation Center (mindroads.com) in St. Paul and Minneapolis’ Common Ground Meditation Center (commongroundmeditation.org) offer flexible classes and programs for beginners as well as experienced meditators.
Recognize the Importance of Support In 2014, the American Psychological Association surveyed respondents about the levels of emotional support in their lives—from a spouse or partner, family, or close friend. Those who lack emotional support rank their stress as 6.2 out of 10, compared to 4.8 for those with support, and nearly half of those without support report feelings of depression or sadness in the last month (compared to less than a third for those who have support).
See a Professional Some find benefits from seeing stress specialists, who focus on relaxation techniques, holistic health care, and coping. For dealing with specific life events such as loss of a loved one or a job, trained counselors can offer plans for getting through. When there’s a need for working through issues that underpin stress and anxiety, there any several paths to therapy and a variety of trained experts who can help.
Stress by the Numbers
Average American’s self-reported stress level in 2014 (with 1 meaning “little or no stress” and 10 meaning “a great deal of stress”)
Level of stress considered by Americans to be healthy
5.2, 4.5., 4.7
Average reported stress level for women, men, and parents, respectively
Percentage of adults who say that they aren’t doing enough, or aren’t sure they’re doing enough, to manage stress
Percentage of adults who say they feel stress about money “at least some of the time” (the greatest cause of stress, with work second)
Percentage of women who report lying awake at night due to stress in the past month (versus 32 percent for men)
Percentage of Minnesotans who reported to a 2012 Gallup survey that they felt stressed at some time during the previous day (ranking 13th-least stressed in the nation)