The Biggest Cause of Anxiety and Depression Is Traumatic Life Events

Article Source: Health And Fitness Journal

By Dr. Mercola

It’s estimated that 1 in 10 U.S. adults struggle with depression1 and another 40 million have anxiety. It’s quite common, too, for someone with depression to also have anxiety. In fact, close to half of those diagnosed with depression are also diagnosed with anxiety.2

There’s no doubt that both of these mental health conditions are at epidemic proportions, but the unanswered question remains why? Oftentimes you hear about depression or anxiety running in families, which leads to an assumption that your genetics may be to blame.

Another popular theory is that depression is due to some sort of ‘chemical imbalance’ in your brain (more on this later). But the truth is, in most cases no one really knows why some people are depressed or anxious while others are not, and most likely there are multiple factors at play.

Among them, and perhaps most important, could in fact be your life experiences, and particularly your experience of traumatic events.

Traumatic Life Events at the Root of Many Cases of Anxiety and Depression

A new study set out to determine what role familial risk, social circumstances and life events have on mental health, using surveys completed by nearly 33,000 people as their key form of data.3

They revealed that the single biggest determinant of anxiety and depression was traumatic life events, followed by to a lesser extent, family history of mental illness, income and education levels, relationship status and other social factors. According to the study’s lead author:4

“Whilst we know that a person’s genetics and life circumstances contribute to mental health problems, the results showed that traumatic life events are the main reason people suffer from anxiety and depression.

However, the way a person thinks about, and deals with, stressful events is as much an indicator of the level of stress and anxiety they feel.

Whilst we can’t change a person’s family history or their life experiences, it is possible to help a person to change the way they think and to teach them positive coping strategies that can mitigate and reduce stress levels.”

This is key, as it means that you are not powerless against depression and anxiety. Rather, it’s possible to modify the way you think about traumatic life events in order to minimize their impact on your mental health. Antidepressant drugs, of course, will do nothing to help in this regard.

20 Percent of Population May Have a Gene Variant Linked to Depression

Brain Derived Neurotrophic Factor (BDNF), is a key growth hormone that promotes healthy brain neurons and plays a vital role in memory. BDNF levels are critically low in people with depression, which animal models suggest may actually be a primary contributing cause.

Now researchers have determined that an alteration known as a single nucleotide polymorphism (SNP) in the BDNF gene may further contribute to the risk of anxiety, depression and memory loss. All it takes is for one ‘letter’ of BDNF’s genetic code to be ‘misspelled’ for the alteration to occur.

The SNP alteration not only decreases BDNF in neurons but also generates a protein (called Met66) that is different from the one produced by people without the alteration.

About 20 percent of the US population is thought to have the BDNF SNP that produces the Met66 protein, which, in turn, has been found to induce shrinking of neurons in the hippocampus, in areas of the brain important for memory and emotions. The shrinkage would reduce the connectivity between brain cells.

One of the study’s researchers noted:5

“There can be a heritable component to these diseases and it makes sense that a common variant in a gene could be involved … Just like hypertension contributes to the risk for heart disease, the BDNF alteration increases the risk of depression, anxiety and memory disorders — but is not the sole reason why they occur.”

The researchers are currently looking to develop drugs that would target Met66 or block the proteins it binds to in people with the BDNF SNP alteration. However, it would be interesting to see how natural methods that promote optimal genetic expression would work instead.

Growing evidence indicates that both fasting and exercise trigger the expression of genes and growth factors that recycle and rejuvenate your brain tissues. These growth factors include BDNF, which is known to be released in response to the stress of exercise.

BDNF activates brain stem cells to differentiate into new neurons, while also triggering numerous other chemicals that promote neural health. Perhaps it is no coincidence, then, that exercise is also one of the best-known treatments for depression …

What About Chemical Imbalances?

As a physician, I have treated many thousands of depressed patients. Depression was actually one of my primary concerns in the mid-80s when I first started practicing. However, at that time my typical treatment tool was using antidepressants alone. I put thousands of people on these drugs and acquired a fair level of experience in this area.

Thankfully, I learned more methods of treatment and was able to pretty much stop drugs. It was my experience that the chemical imbalance theory was merely a massive marketing gimmick to support the use of expensive and toxic antidepressants.

Most of you have probably heard that depression is primarily due to a “chemical imbalance in your brain,” which these drugs are designed to correct. Unfortunately this is not a scientific statement. So where did it come from?

The low serotonin theory arose because they understood how the drugs acted on the brain; it was a hypothesis that tried to explain how the drug might be fixing something.

However, that hypothesis didn’t hold up to further investigation. Investigations were done to see whether or not depressed people actually had lower serotonin levels, and in 1983 the National Institute of Mental Health (NIMH) concluded:

“There is no evidence that there is anything wrong in the serotonergic system of depressed patients.”

The serotonin theory is simply not a scientific statement. It’s a botched theory—a hypothesis that was proven incorrect. The fact that this fallacy continues to thrive is likely harming the health of millions more than it’s helping, because if you take an SSRI antidepressant drug that blocks the normal reuptake of serotonin, you end up with the very physiological problem the drug is designed to treat–low serotonin levels.

Which, ironically, is the state hypothesized to bring on depression in the first place. In 1996, neuroscientist Steven Hyman, who was head of the NIMH at the time, and is today president of the society for Neuroscience, published the paper Initiation and Adaptation: A Paradigm for Understanding Psychotropic Drugs,6 in which he explains this chain of events.

According to Dr. Hyman, once your brain has undergone a series of compensatory adaptations to the drug, your brain operates in a manner that is “both qualitatively and quantitatively different than normal.”

So, it’s important to understand that these drugs are NOT normalizing agents. They’re abnormalizing agents, and once you understand that, you can understand how they might provoke a manic episode, or why they might be associated with sexual dysfunction or violence and suicide, for example.

How to Reprogram Your Thinking About Traumatic Events

Getting back to the original study that found traumatic life events are the major determining factor in depression and anxiety – but that the way you think about them is an equally strong determining factor, let’s discuss how you can overcome such an emotional hurdle. The Emotional Freedom Techniques (EFT) is a form of psychological acupressure based on the same energy meridians used in traditional acupuncture to treat physical and emotional ailments for over 5,000 years, but without the invasiveness of needles.

Instead, simple tapping with the fingertips is used to transfer kinetic energy onto specific meridians on your head and chest while you think about your specific problem — whether it is a traumatic event, an addiction, pain, anxiety, etc. — and voice positive affirmations. This combination of tapping the energy meridians and voicing positive affirmation works to clear the “short-circuit”—the emotional block—from your body’s bioenergy system, thus restoring your mind and body’s balance, which is essential for optimal health and the healing of physical and mental disease.

Some people are initially wary of these principles that EFT is based on — the electromagnetic energy that flows through the body and regulates our health is only recently becoming recognized by western medicine. Others are initially taken aback by (and sometimes amused by) the EFT tapping and affirmation methodology.

But believe me when I say that, more than any traditional or alternative method I have used or researched, energy psychology (EFT being one type) has the most potential to literally work magic in this area. Clinical trials have shown that EFT is able to rapidly reduce the emotional impact of memories and incidents that trigger emotional distress. Once the distress is reduced or removed, the body can often rebalance itself, and accelerate healing. In the video above, EFT practitioner Julie Schiffman shows how you can use EFT to even get rid of panic attacks.

The Gut Connection to Anxiety and Depression

Another factor worth mentioning is that unhealthy gut flora can impact your mental health, leading to issues such as anxiety, depression, autism and more. Research has found, for instance, that the probiotic Lactobacillus rhamnosus had a marked effect on GABA [an inhibitory neurotransmitter that is significantly involved in regulating many physiological and psychological processes] levels in certain brain regions and lowered the stress-induced hormone corticosterone, resulting in reduced anxiety- and depression-related behavior.7

Interestingly, just as you have neurons in your brain, you also have neurons in your gut, including neurons that produce neurotransmitters like serotonin, which is also found in your brain. In fact, the greatest concentration of serotonin, which is involved in mood control, is found in your intestines, not your brain! (Perhaps this is another reason why antidepressants, which raise serotonin levels in your brain, are often ineffective in treating depression, whereas proper dietary changes often help.) This is where dietary changes such as reducing sugar intake and increasing your intake of probiotic-rich fermented foods can be invaluable for mood support.

Six Additional Factors for Improving Your Mental Health

There’s no doubt in my mind that addressing traumatic life events is a crucial step to prevent and/or address depression and anxiety. That said, here are six additional strategies that can help you even further:

  1. Exercise – If you have depression, or even if you just feel down from time to time, exercise is a MUST. The research is overwhelmingly positive in this area, with studies confirming that physical exercise is at least as good as antidepressants for helping people who are depressed. One of the primary ways it does this is by increasing the level of endorphins, the “feel good” hormones, in your brain. It also helps to normalize your insulin and leptin signaling.
  2. Eat a healthy diet – A factor that cannot be overlooked is your diet. Foods have an immense impact on your mood and ability to cope and be happy, and eating whole foods as described in my nutrition plan will best support your mental health. Avoiding sugar and grains will help normalize your insulin and leptin levels, and eliminating artificial sweeteners will eliminate your chances of suffering its toxic effects.
  3. Optimize your gut health – Fermented foods, such as fermented vegetables are also important for optimal mental health, as they are key for optimizing your gut health. Many fail to realize that your gut is literally your second brain, and can significantly influence your mind, mood, and behavior. Your gut actually produces more mood-boosting serotonin than your brain does.
  4. Support optimal brain functioning with essential fats – I also strongly recommend supplementing your diet with a high-quality, animal-based omega-3 fat, like krill oil. This may be the single most important nutrient to battle depression.
  5. Get plenty of sunshine – Making sure you’re getting enough sunlight exposure to have healthy vitamin D levels is also a crucial factor in treating depression or keeping it at bay. One previous study found that people with the lowest levels of vitamin D were 11 times more prone to be depressed than those who had normal levels. Vitamin D deficiency is actually more the norm than the exception, and has previously been implicated in both psychiatric and neurological disorders.
  6. Address your stress – Depression is a very serious condition, however it is not a “disease.” Rather, it’s a sign that your body and your life are out of balance. This is so important to remember, because as soon as you start to view depression as an “illness,” you think you need to take a drug to fix it. In reality, all you need to do is return balance to your life, and one of the key ways to doing this is addressing stress. Meditation or yoga can sometimes help. If weather permits, get outside for a walk. But in addition to that you can also use EFT, as mentioned.

If you have been personally affected by depression or anxiety my heart goes out to you. A broken body can be easier to fix than a broken mind. Depression and anxiety are real. It is my hope that you will be encouraged and inspired by the information in this article to help those who are struggling.

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How Junk Food Companies Have Hijacked Nutritional Science

Article Source: Health And Fitness Journal

By Dr. Mercola

Since its inception in 1928, the American Society for Nutrition (ASN)1 has become the most widely known academic institution in the field of nutrition, publishing three academic journals, including the well-respected American Journal of Clinical Nutrition.

As a result, you’d expect the ASN’s advice to be on solid ground. Alas, as noted in a June 2015 report2 by Michele Simon, “The ASN has many problematic ties with the food and beverage industry.” 

These ties can “taint scientific objectivity, negatively impact the organization’s policy recommendations, and result in industry-friendly research and messaging that is shared with nutrition professionals and the general public alike,” she adds.

According to Michele:

“Obesity researcher David Allison wins the prize for the most conflicts: PepsiCo, the Sugar Association, World Sugar Research Organization, Red Bull, Kellogg, Mars, Campbell Soup, and Dr. Pepper Snapple.

Perhaps most troubling, Allison serves on the editorial board of the American Journal of Clinical Nutrition, ASN’s flagship publication.

While his conflicts are disclosed, having Allison in such a critical gatekeeper role demonstrates how industry can potentially influence even the science that gets published.”

Michele Simon has practiced public health law for nearly 20 years, fighting corporate tactics that deceive and manipulate you about health.

The featured interview with her was done in 2013, following her expose’ on the junk food industry’s ties to the Academy of Nutrition and Dietetics  (AND) and its insidious influence over registered dieticians (RDs).

In her latest report,3,4 “Nutrition Scientists on the Take from Big Food—Has the American Society for Nutrition Lost All Credibility?”, Michele reveals the disturbing ties between American Society for Nutrition (ASN) — a premier source of nutritional science — and the primary purveyors of obesity and chronic ill health.

Primary Purveyors of Obesity and Chronic Disease Sponsor Nutrition Science and Public Education

The ASN is commonly viewed as an independent and science-based source of nutritional information, but how independent can it really be when it is sponsored by Coca-Cola, Kellogg’s, Monsanto, and the Sugar Association, just to mention a few?

In all, the ASN is sponsored by 30 different companies, each of which pays $10,000 a year in return for “print and online exposure, annual meeting benefits, and first choice to sponsor educational sessions, grants, awards, and other opportunities as they arise.”

As noted by Michele:

“In other words, food, beverage, supplement, biotech, and pharmaceutical industry leaders are able to purchase cozy relationships with the nation’s top nutrition researchers.”

Junk food purveyors gain even more influence by sponsoring educational sessions at various conferences and annual meetings, and featuring speakers that represent the industry.

Some of these relationships are obvious, while others are less so, obscured as it were by affiliations with various industry front groups.

Why Is ASN Promoting Processed Foods?

As noted in Michele’s report, the ASN’s Public Information Committee was formed to “promote ASN as the premier source of sound nutrition science information to the media and public.”

Objective interpretation of nutrition science, transparency, and nutrition literacy are three values the committee claims to uphold, yet many of the ASN’s recommendations have the junk food industry’s fingerprints all over it…

For example, in April 2014, the ASN published a scientific statement titled “Processed Foods: Contributions to Nutrition.” This is an abomination to the primary health directive which is to avoid processed foods and eat REAL food.

However, the ASN claims that processing does not necessarily result in a nutritionally inferior product, adding that processed foods can address the obesity epidemic through the use of artificial sweeteners, nanotechnology, and flavor chemistry.

The report also foolishly claims that there are “no differences” between industrial food processing and processing of food in your own kitchen — noting that cleaning and peeling are types of food “processing” as well — significantly downplaying the very real effects industrial processing has on the quality of the food.

They fail to mention the thousands of artificial chemicals added that have been approved by industry as GRAS and never been tested for safety. These chemicals are added during processing, and then to make the food palatable once processed, something that does NOT happen in your kitchen!

Moreover, the ASN report claims that descriptions, such as “minimally processed” and “ultra-processed”, are “value-laden terms” that fail to characterize foods in a helpful manner. As noted by Michele:

“This defense of processed foods from a nutrition organization makes sense considering ASN’s sustaining partners, all of whom have a financial stake in getting Americans to purchase processed foods – whether it’s Kellogg’s Pop Tarts, General Mills’ Cookie Crisp Cereal, PepsiCo’s Doritos, or McDonald’s chicken nuggets.”

ASN Doesn’t Believe in Warning You About Added Sugars

The ASN has also taken a firm stand against the US Food and Drug Administration’s (FDA) proposal to list “added sugar” on the Nutrition Facts label of processed foods, stating that:

“[A] lack of consensus remains in the scientific evidence on the health effects of added sugars alone versus sugars as a whole,” and that “The inclusion of added sugars on the label may confuse consumers and create the perception that naturally occurring sugars are somehow more beneficial because they are ‘natural’ and do not have health effects similar to added sugars.”

This is a position you’d expect from the sugar industry, and not surprisingly, the Sugar Association is one of the ASN’s sponsors.

As noted by Michele, “Naturally occurring sugars come bundled with nutrients, whereas added sugar only contributes calories, with zero nutrition. In that sense, naturally occurring sugars (consumed within whole foods) are more beneficial. This is basic nutrition science, and it is why eating an apple or peach is vastly different from eating candy.”

As the premier organization for nutritional science, the ASN’s outdated stance on sugars and fats is suspicious to say the least, and its defense of highly processed junk food is downright unconscionable, considering the overwhelming scientific evidence linking a processed food diet to metabolic dysfunction, obesity, and chronic disease.

There Is a FAR Better Alternative to ASN

Thankfully, we don’t have to rely on organizations like the American Society of Nutrition that is paid off by the junk food industry to promote processed foods. One of the best organizations out there is the American College of Nutrition and they have not sold out to industry. They are committed to teaching authentic health principles that address the cause of disease. I have been a fellow of this organization for a number of years now. 

Later this month, I will be interviewing Michael Stroka, who is the president of the organization and hopefully will air the interview before the fall. We plan on reviewing the teaching programs they have in place and also the ability to certify individuals who understand the type of nutrition that I discuss on this site. Interestingly, I treated Michael as a patient many years ago, and he was so excited to regain his health that he changed careers and now heads this far better alternative to ASN.

Sugary Drinks Responsible for 184,000 Deaths Each Year

I’ve written extensively on the research linking processed foods and sugary beverages to poor health. Most recently, a team of investigators set out to estimate the global death toll attributed to sugary beverages, concluding that sodas and other sweetened drinks likely cause at least 184,000 premature deaths each year 5,6,7,8  primarily by fueling chronic diseases, such as diabetes, heart disease, and cancer.

According to senior author Dr. Dariush Mozaffarian, substantially reducing or eliminating sugar-sweetened beverages from the diet should be a “global priority,” noting:“This is not complicated. There are no health benefits from sugar-sweetened beverages, and the potential impact of reducing consumption is saving tens of thousands of deaths each year.”

The American Beverage Association countered the findings saying that, “The study does not show that consuming sugar-sweetened beverages causes chronic diseases,” completely ignoring the fact that how sugar and fructose causes chronic disease has already been established by other studies. For example, in one clinical trial, test subjects who consumed high-fructose corn syrup (HFCS) developed higher risk factors for cardiovascular disease in just two weeks.

Another paper9 published in JAMA Internal Medicine last year looked at consumption of added sugar over two decades, as a percentage of total calories, concluding that it significantly contributed to cardiovascular deaths. People who consumed 30 percent of their daily calories as added sugar (like many teenagers are) had a four-fold greater risk of dying from heart disease.

Considering how much refined sugar and processed fructose children are now consuming, the impact on mortality statistics will only get worse as years to by— unless a significant change in diet takes place. Disturbingly, it’s the very change needed that the American Society for Nutrition (ASN) is actively counteracting with its support of processed foods and beverages.

Data from a recent report by the UK’s Health and Social Care Information Center reveals that one-quarter of children entering primary school are overweight or obese, and by the time they leave, that ratio rises to one-third. Dr Colin Michie of the Royal College of Pediatrics and Child Health told the BBC:10

“With this cohort of enormous children, if not obese children, coming through to adulthood, we are facing an enormous problem for those delivering clinical care.”

Artificial Ingredients — Another Health Hazard That Cannot Be Ignored

It’s important to realize that high-sugar content is not the only hazard of processed foods and beverages. Artificial ingredients also contribute to obesity and chronic disease. Artificial sweeteners, for example, have overwhelmingly been shown to promote weight gain rather than curb it.

Recent research11 also suggests that an additive used in some soft drinks, including Hawaiian Punch and Fanta, can increase your risk of weight gain by altering how your body responds to calories. Remember that these ingredients were approved by the industry as GRAS (Generally Recognized as Safe) and NEVER tested for human safety.

According to Environmental Health News:12

“The chemical is used as a laxative and in sodas to help ingredients mix properly. It’s also a major ingredient in Corexit, the dispersant applied by the millions of gallons in the Gulf of Mexico during the 2010 Deepwater Horizon disaster. But the chemical, dioctyl sodium sulfosuccinate, or DOSS, is a likely member of a family of chemicals contributing to obesity, researchers say in a study published today in the Environmental Health Perspectives journal…

Temkin and colleagues exposed mouse and human cells to different oil dispersant mixtures. DOSS increased genes associated with fat cells and activated receptors that spur the process of non-mature fat cells turning into mature fat cells. ‘That a chemical causes more fat cells is concerning,’ Blumberg said… That the chemical has been on the market for decades but is only now seen as possibly problematic offers further indictment of an inadequate federal chemical testing regime…”

Unreasonable Corporate Growth Expectations Corrupt Nutritional Science and Public Health Recommendations

Zoë Harcombe’s excellent book, The Obesity Epidemic,13 succinctly discusses how unreasonable expectations of corporate growth more or less automatically generate conflicts of interest, noting that: “The fact that real growth can never be sustained seems to have been overlooked by financial markets and investors.”

Indeed, it is the food manufacturers’ responsibility to share holders and their own bottom line that has led to a system where scientific truth has been placed on the backburner. Moreover, processed food companies rely on public health advice to be in agreement with their offerings — anything else would be devastating to their bottom line. And if such advice is short in the offing, the industry will resort to measures to protect its place as purveyors of “healthy nutritious food,” opposed to the truth, which is that a processed food diet will hasten death…

One solution that places the junk food industry in the driver’s seat is to infiltrate nutritional organizations such as the ASN. Better yet, by restricting the “legal” dissemination of dietary advice to one national organization, the processed food industry can even more effectively secure its own future, and that’s exactly what we have with the US Commission on Dietetic Registration (CDR), the credentialing agency for the American Dietetic Association.

Most states in the US (46 out of 50) have passed laws to regulate who is legally allowed to provide nutritional advice, restricting this “right” to registered dieticians (RDs). Unless you’re an RD, you are practicing a profession without a license, and are subject to prosecution.

As noted by Harcombe:

“Dietitians in America, therefore, enjoy a unique monopoly position and they have unfettered access to hospitals, schools, large institutions, prisons—all public health diet advice… dietitians also have sole access to private health advice. So, it is critical for us to know who is behind this monopolistic advice.”

Not surprisingly, partners of the American Dietetic Association include Coca-Cola, GlaxoSmithKline, the National Dairy Council, PepsiCo, and Unilever. Other premium sponsors also include Abbott Nutrition, Cargill, General Mills, Kellogg’s, Mars, SoyJoy, and Truvia, which provide the association with $467 billion in sponsorships! The US is not alone in this situation. Similar nutrition monopolies have been set up in Australia and the UK, for example, and are funded by the same multinational processed food companies.

Take Action: Tell the American Society for Nutrition to Stop Bowing to the Junk Food Industry

The American Society for Nutrition (ANS) presents itself as an independent organization aimed at investigating and educating you about nutrition to prevent disease and promote health. The reality, however, is that the ANS is deeply entrenched with and beholden to junk food corporations, whose interests have very little to do with promoting good health, and everything to do with selling their products, no matter what the health impact may be. This kind of conflict of interest cannot be permitted to continue unchallenged.

The Alliance for Natural Health (ANH)14 has created a petition urging the American Society for Nutrition to stop pandering to and speaking for the junk food industry. If you’re as concerned about this as I am, please take a moment to sign the petition right now.

For Good Health, Eat REAL Food

If you want to be healthy, there are no substitutes for REAL food, meaning foods that you buy whole and cook from scratch. As a general rule, a diet that promotes health is high in healthy fats and is very, very low in sugar and non-vegetable carbohydrates, along with a moderate amount of high-quality protein.

For more specifics, please review my free optimized nutrition plan, which also includes exercise recommendations, starting at the beginner’s level and going all the way up to advanced. Organic foods are generally preferable, as this also cuts down on your pesticide and GMO exposure.

If you’re unsure of where to find wholesome local food, the following organizations can help:

  • Local Harvest – This Web site will help you find farmers’ markets, family farms, and other sources of sustainably grown food in your area where you can buy produce, grass-fed meats, and many other goodies.
  • Eat WildWith more than 1,400 pasture-based farms, Eat Wild’s Directory of Farms is one of the most comprehensive sources for grass-fed meat and dairy products in the United States and Canada.
  • Farmers’ Markets – A national listing of farmers’ markets.
  • Eat Well Guide: Wholesome Food from Healthy Animals — The Eat Well Guide is a free online directory of sustainably raised meat, poultry, dairy, and eggs from farms, stores, restaurants, inns, and hotels, and online outlets in the United States and Canada.
  • FoodRoutes – The FoodRoutes “Find Good Food” map can help you connect with local farmers to find the freshest, tastiest food possible. On their interactive map, you can find a listing for local farmers, CSA’s, and markets near you.

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When Elderly Parents Suck The Life Out Of Their Kids

Article Source: Health And Fitness Journal

My patient’s son stood vigil outside her hospital room day and night. His eyebrows were frozen at an anxious angle. Although his mom was healing well from her injury, I could see that he was worried about next steps. He asked staff repeatedly about his mom’s pain management, and reviewed every therapy session she attended.

His mom, on the other hand, was deceptively charming. She was a thin, well-groomed elderly woman who knew how to exact empathy from others. When I looked into her room from a distance she appeared comfortable, lying in her hospital bed covered in a quilt that her son had brought her from home. When I entered the room to check on her, she would grab my hand and wince, telling me that the pain was severe but that she didn’t want any medication. She was quite invested in convincing me that she was unable to go home and care for herself, and that she needed to be discharged to her son’s home. She would not accept others help at home, nor would she go to a skilled nursing facility.

She was doing well in therapy, limited mostly by her macular degeneration (poor eyesight). Again, I watched her from outside her field of vision. I saw her stand without assistance, push her walker across the room, and navigate a couple of stairs. I heard her speak to her son in angry and dismissive tones. When she saw me approach her knees buckled and she crumpled to a padded bench. “I am not safe to go home, doctor.” She said. And her eyes filled with tears – “I am going to fall and no one will know.”

I took her son to a private room to discuss the predicament. I carefully raised the subject of how his mom was doing well physically, and could discharge home safely with home health services, but was angling for a discharge to his house. I asked him some open ended questions and learned that he was her only son, that his mom had been guilting him about quitting his job to care for her full time.

He became tearful – “I have only a few more years to go before I can collect my pension. Mom knows this but wants me to quit right now and move back home. If I do that I won’t have enough money to survive my own retirement. She has no friends and dad died several years ago. She says she doesn’t want any hired help at her house, and she cries when we discuss nursing homes. She says if I love her I will let her live with me. But I don’t have time to help her during the day. What am I supposed to do? She has been doing this to me all my life – getting me to do what she wants!”

I decided to tell him the unvarnished truth.

“I can see that your mom can be quite manipulative, and this has been an ongoing struggle. You need to take care of yourself. The fact that she wants to be with you 24/7 does not prove her love — a loving mom would not ask her son to jeopardize his financial future so that she wouldn’t have the ‘discomfort’ of caregivers in her home. Do not feel guilty about continuing to work. Her insurance will cover the care she needs. It’s ok to say no to her. That’s my professional opinion.”

The son let out an audible sigh. He thanked me profusely for telling him the truth. I told him that it was entirely possible that his mom would fall down on purpose once out of the hospital, to try to get him to change his mind. I warned him not to let her consume his life. She likely had a personality disorder that made her capable of squeezing the very life out of him.

My patient ended up discharging to a very nice skilled facility that her son had pre-screened for her. She was as happy as a wet cat on departure, but I believe it was the right decision for both of them. I just hope that she didn’t succeed in wrapping her emotional constrictor muscles around the neck of her poor son again. I tried my best to save him, but in the end I know that sometimes people have to save themselves.

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