Hoarding and Psychotherapy with Stelios Kiosses

"We trained pregnant and never pregnant women and we tested them on their memory for these items immediately after they learned them and then we tested them two weeks later, looking at their long term autobiographical memory. What we found was that for the immediate test, the pregnant women did better than the never pregnant women on the baby relevant items, but they had equal performance on the adult oriented items. That gives some support to our hypothesis that when you actually test for benefits in cognition for ecologically relevant items you see them in pregnancy. But very surprisingly to us, I think the most interesting finding  was that when we tested memory two weeks later, the pregnant women do better than the never pregnant women on all of the items. They were retaining much more information across time than the never pregnant women. This was evidence for a general cognitive enhancement during pregnancy that was not specific to ecologically relevant items."    Episode Description: We begin with a description of what 'mommy brain' is as it is understood in the lay and the scientific literatures. Subjectively, many women describe memory deficits during and after pregnancy, yet objective measures generally do not demonstrate these changes. Bridget's and others' research found that rather than 'deficit' what is taking place is an evolutionarily advantageous specialization of the brain orienting the mother to the revolutionary task of birthing and caring for a new human being. We discuss the brain changes in father's brains that appear to be related to the degree of caretaking in which they are immersed. We discuss neural plasticity, the adult recapitulation of one's own childhood experiences, and the interface with depression and anxiety during these periods of flux in one's life. We close with Bridget sharing with us the importance to her of sharing accurate scientific findings with the general public as well as her wish list for future research.    Listen to EPISODE 1: THE MICROBIOME IN CHILD DEVELOPMENT WITH BRIDGET CALLAGHAN, Ph.D.   Our Guest: Bridget Callaghan, Ph.D., is an Assistant Professor of Psychology at UCLA who studies how early life experiences influence interactions between mental and physical health across the lifespan, influencing intergenerational patterns of well-being. She received her Bachelor’s degree in Psychology, her Masters in Clinical Psychology, and her Ph.D. at the University of New South Wales, Australia. She has worked clinically in the field of developmental psychology and completed her postdoctoral training at Columbia University in New York in 2019. Dr. Callaghan’s research has been generously funded through the National Institutes of Mental Health, Brain Behavior Research Foundation, and National Health and Medical Research Council of Australia. She is the recipient of the APS Rising Star Award, the Federation for the Association of Brain and Behavioral Sciences Early Career Impact Award, and the Kucharski Young Investigator Award. She has active collaborations with researchers at New York University, the University of New South Wales and Sydney Children’s Hospital in Australia, Telethon Kids Institute Australia, and the University of Fukui in Japan.  

"The universality of guilt - I think that my life as a child therapist has a lot of advantages; we carry the idea that ‘we are all the ages we've ever been’ and those magic years never disappear. There are some great things about that - there are some problems with it too. That kind of irrational self-centered construction to explain what is intolerable and difficult to grasp comes from that. Early in this whole process, I remember talking to the pediatrician taking care of us: ‘Was it something in the environment? Was it the street we lived on? Was it that we lived in the basement? Was that an explanation? How close we were to the boiler room?  What could it be?’ And he just looked through all of that to say: ‘You did nothing wrong’. It stays with me as I remember it - how potent that was. There's a part of me that wants to keep manufacturing the explanation that I can get my head around, and there's something penetrating about realizing that those explanations don't serve."    Episode Description: We begin with Phil sharing with us the family tragedy that is described in his book A Short Good Life. It describes the illness and death of his younger daughter Liza, who he says is his second child. When I ask him about his use of the present tense, he says that he "is parenting her memory." He describes the process of writing this book and the help he sought from other parents who have lost children. He reads sections from the book that allow us to listen in on Liza's struggles with her older sister, her facing the guilt of imagining having caused her leukemia, and then her efforts to come to terms with her dying - at the age of six. We conclude with Phil's evolution as a therapist, which now includes his use of psychedelics to assist those who are struggling with trauma. I share how grateful I am to have learned of his work and how he has brought forth something special for others to learn from what I consider to be a tutorial on love. Our Guest: Philip Lister, M.D., is an adult and child psychiatrist and an adult and child psychoanalyst working in private practice. He is the author of a memoir, A Short Good Life, based on the experience of his family as his second child faced her death due to cancer. In addition to private practice, he is involved with MAPS (Multidisciplinary Association for Psychedelic Studies), working as a therapist in the research study using MDMA-Assisted Therapy for the treatment of PTSD. Dr. Lister can be reached through his website https://ashortgoodlife.com/   Linked Episode: Episode 23: Psychedelic Psychotherapy for PTSD Recommended Readings: https://ashortgoodlife.com/resources/  

"Because I couldn't help my son, I couldn't do anything for him, I thought maybe I could start this group and help other people and other parents deal with this problem. What I wasn't prepared to face was just how lonely, how alone, how sad, and feeling hopeless I was.  In a way, when the group began, I needed the group as much as the group needed me. I've continued the group although I need it for different reasons - at that point I needed it because I felt overwhelmed because of the problem with my son. Now I need it because I’ve grown to love the people of the group and I feel a tremendous sense of connection with them,I care for them deeply, and it is a very meaningful part of my life."   Episode Description: We begin with the definition of stigma and how it exists as a force from outside of oneself as well as an internal state of self-disdain. It can be a cause of emotional difficulties and also a result of the label of mental illness. We discuss the symptoms of depression and how it differs from sadness, especially noting the role of guilt and self-hatred. John describes a group that he began 25 years ago that is affiliated with the Depression and Bipolar Support Alliance - DBSA. He walks us through the process of participating in the group and, in conjunction with individual treatment, describes the ways that it is a powerful force for healing. He also shares with us his personal journey of being a father of a son with bipolar illness, which originally inspired the creation of this group. He welcomes participants from around the world who can participate in his online group.   Our Guest: John S. Tamerin, M.D., practices clinical psychiatry in Greenwich, Connecticut. He serves as a Clinical Associate Professor at the Weill/Cornell Medical College where he has taught resident psychiatrists and medical students for over thirty years. Dr. Tamerin has twice been honored by the graduating residents in the Department of Psychiatry and chosen Teacher of the Year.   Dr. Tamerin has served as a member of the Board of Scholars of the Vail Leadership Institute. He has been a faculty member of the Yad Vashem Center of Holocaust Studies in Jerusalem. He has been a member of the Board of Directors and serves on the Scientific Advisory Board of the National Depression and Bipolar Alliance (DBSA). Dr. Tamerin is currently the President and the psychiatric consultant to the Greenwich, Connecticut, Chapter of the National Depression and Bipolar Alliance.   Dr. Tamerin is an enthusiastic jazz musician who plays the alto saxophone. He is also a competitive tennis player who participated as a member of the USA Grand Master’s Tennis Team in the 20th World Maccabiah Games in Israel in 2017 and was awarded gold and silver medals in doubles and singles. He currently, at age 85, plays singles 5x a week year round and last year competed in the world championships for his age group.   

"If you randomly assign people in two groups and you give them different insignia or you have them go through different practices, as we saw in this study, they come to like each other more. It's very easy to create this basic sense of belonging and identity. Ritual is particularly good at eliciting that kind of sense also because it triggers our intuitions about what we call phenotypic matching, this is the idea that we have ways, psychological mechanisms, that allow us to recognize those that are members of our groups, especially kin, so if you think about it who are your kin, they're the people who are most likely to look like you, they're the people who are most likely to behave like you, they're also the people that you go through emotional things with, you go through laughter and crying and traumatic experiences with, those are the people we call family. A lot of rituals, collective rituals, they replicate all of those things, so they make people wear the same insignia, so our appearances are aligned, they make people perhaps move in synchrony, so our movements are alike, and sometimes, they also involve people going through highly emotional things, in both pleasure and joy, in like in a wedding, dancing, tearing, and chanting together, but they can also involve crying and sadness, like taking part in the same funeral or even perhaps pain, like going through a painful initiation ceremony."   Episode Description: We begin by describing the results of an experiment where children given meaningless rituals to perform in association with a task formed tighter and more exclusive bonds with those in their group as compared with children given the same task without the rituals. The role of rituals, through rigidity, repetition, and redundancy, empowers greater group affiliation, especially if pain is built into the ritual. We discuss "collective effervescence" — synchronous arousal common to those participating in sporting events, religious ceremonies, and political rallies. Dimitris mentions the role of deities in these rituals as well as those rituals that are inherently involuntary, ie, genital mutilation. He shares with us his experience walking on coals and how it impacted his esteem and group attachment. We close with his describing how he utilizes rituals in his current family life.   Our Guest: Dimitris Xygalatas, Ph.D. is an anthropologist and cognitive scientist at the University of Connecticut, where he directs the Experimental Anthropology Lab. His research interests focus on some of the most puzzling yet deeply meaningful aspects of human behavior. He has been studying ritual for over two decades, conducting several years of fieldwork and combining ethnographic and experimental methods. His work has been published in over 100 scientific articles and books. His latest book is Ritual: How Seemingly Senseless Acts Make Life Worth Living, by Little Brown.  

"One of the things that is very exciting is that this is a very robust finding. In other words, sometimes in science people see something and then it's not replicated - Rapamycin’s impact on lifespan has been replicated. When I started researching this area 50 years ago, I never felt that we would find a pill that would have an impact on aging and lifespan. Aging is very complex - to find one thing that would have an impact was highly unlikely. So when this happened in 2009, I had a small part in this, it was really very exciting because for the first time we had something that could potentially work in humans. The really exciting thing was this was a drug that was already being used in humans so we the knew the downsides and upsides to this particular compound."     Episode Description: We begin by recognizing that many longevity researchers, including Professor Richardson, anticipate that Rapamycin dosed intermittently will lead to significant lifespan and healthspan improvements. This has not yet been shown in humans though it has been robustly demonstrated in all animals tested. Its ability to improve immunologic functioning in individuals over 65 years of age has been demonstrated. We discuss the improvement in animal models of Alzheimer's Disease, and there has been some indication that these animal effects also apply to human subjects. The fascinating history of the discovery of Rapamycin from a soil sample from Easter Island (Rapa Nui) is described, and the role of serendipity in the history of science is recognized.    Our Guest: Arlan Richardson earned his Ph.D. in chemistry/biochemistry from Oklahoma State University in 1968. For the past 50 years, he has devoted his career to studying how aging impacts biological aspects of aging with a goal of identifying interventions that can slow down aging and improve the health of the elderly. He directed the first multi-investigator center grant into the effect of rapamycin on various age-related diseases. He served as president of the American Aging Association and the   Recommended Readings:  Richardson A, Galvan V, Lin AL, Oddo S. How longevity research can lead to therapies for Alzheimer's disease: The rapamycin story. Exp Gerontol. 2015 Aug;68:51-8. doi: 10.1016/j.exger.2014.12.002. Epub 2014 Dec 3. PMID: 25481271; PMCID: PMC6417920.  Blagosklonny MV. Rapamycin extends life-and health span because it slows aging. Aging. 2013 Aug;5(8):592-598. DOI: 10.18632/aging.100591. PMID: 23934728; PMCID: PMC3796212.  Arlan Richardson. Rapamycin, anti-aging, and avoiding the fate of Tithonus, Geroscience. 2021 Jun;43(3):1135-1158.  Selvarani R, Mohammed S, Richardson A. Effect of rapamycin on aging and age-related diseases-past and future. Geroscience. 2021 Jun;43(3):1135-1158. doi: 10.1007/s11357-020-00274-1. Epub 2020 Oct 10. PMID: 33037985; PMCID: PMC8190242. 

"One way a child of Jody’s age deals with loss is that you don’t miss the person, in a sense you can become them. So, I have her step into the mother role, immediately trying to look after the younger ones and then wearing her mother sunglasses - it’s like she becomes her and then you don’t miss her so much. The neighbor is like an analyst figure, and she goes over and talks to this woman, Juliette, a very kind woman. I had Juliette say to her: ‘The way I see it, a death doesn’t happen just once, it’s like we have to keep being reminded that someone is gone - remember her - miss her a little more, until one day we can remember her without all the sad feelings.  I have her to be the model for that for Jody - that’s the way you mourn, you have to keep remembering they’re gone, lose them again, remember them and lose them again’."     Episode Description: We begin with Kerry describing the storyline of her novel which starts with the sudden death of a young mother leaving behind five children and a husband. The story is seen through the eyes of the 13-year-old daughter, Jody, who recounts the family's challenges through her own coming-of-age experiences. Tenderness and humor abound. The poignancy of this novel is made more real as it recounts some of the author's own experiences as a young girl faced with the sudden death of her mother. We discuss the areas of overlap between fiction and reality and how her work as a psychoanalyst informs her ability to represent the thinking of the characters in the book. We discuss being surprised as a writer and a clinician and the ever-present imagining that people are never really dead.    Our Guest:  Kerry L. Malawista, Ph.D. is a writer and psychoanalyst in McLean VA. She is co-chair of New Directions in Writing. Her essays have appeared nationally in newspapers, magazines and literary journals including The New York Times, The Washington Post, The Baltimore Sun, The Boston Globe, Zone 3, Washingtonian Magazine, The Huffington Post, Bethesda Magazine and Arlington Magazine. She is the co-author of Wearing my Tutu to Analysis and Other Stories (2011), The Therapist in Mourning: From the Faraway Nearby (2013), When the Garden Isn’t Eden: More Psychoanalytic Concepts from Life (2022) all published by Columbia University Press, and Who’s Behind the Couch (2017) published by Routledge Press. Meet the Moon is her first novel.    Our conversation about her co-authored book When the Garden Isn’t Eden: More Psychoanalytic Concepts from Life (2022) can be found at   http://ipaoffthecouch.org/2022/11/26/episode-123-teaching-dynamic-therapy-through-storytelling-with-anne-adelman-ph-d-chevy-chase-md-and-kerry-malawista-ph-d-potomac-md/    Kerry has a memoir in press and can be followed at KmalawistaAuthor.com 

"The best way to think about insulin resistance is that it’s pre-diabetes. In the course of developing type 2 diabetes, which we see in much higher rates in people with bipolar disorder compared to the general population, one starts off with normal blood sugar levels but elevated insulin. It is the elevated insulin that pushes the blood sugar down into the normal range. This is typically something that is missed by physicians because there’s been no medical indication to test for it [insulin level]. After the metabolic dysregulation progresses, patients become glucose intolerant, and at that point a doctor may pick up on it because the blood sugar is elevated - not elevated such to say that they have type 2 diabetes but elevated into the glucose intolerant range."     Episode Description: We begin by describing the symptoms of Bipolar Disease and the reasons that make it important to distinguish from depression. We consider the value of measuring insulin levels to determine if there is a contribution of metabolic dysfunction on the course of the psychiatric condition. Over 50% of patients with Bipolar Disease have insulin resistance and those who do, have a more chronic course of illness. We discuss the role of cortisol levels, chronic inflammation, adverse childhood events, and leakage in the Blood Brain Barrier. Metformin is a safe and useful medication that can reverse insulin resistance and remedy Blood Brain Barrier leakage as documented on radiologic assessment. We conclude with Cindy sharing with us her history as a Family Physician and her hope for appreciating the role of metabolic dysregulation in other psychiatric conditions.    Our Guest: Cindy Calkin, MD is a clinical researcher and Associate Professor of Psychiatry and Medical Neuroscience at Dalhousie University, Canada. She is the Medical Director of a unique multidisciplinary clinical research Mood and Metabolism Program that includes psychiatry, endocrinology and metabolism, health physics, biomedical engineering, neuroradiology, and medical neuroscience. Her group uses multimodal testing to collect detailed prospective data. Her innovation and discovery research focuses on mechanisms underlying Treatment-Resistant Bipolar Depression (TRBD) and novel mechanism-based targeted treatments. 

"When paternity leave comes into the picture you have a situation where parents are home together. Those processes are able to develop for both the mother and the father - there’s time for fathers to bond with their children, there’s time for parents to figure out how to be  parents together. It’s not so lopsided where mothers become the experts because they are there all the time. Mothers and fathers can develop that expertise together because they are both there at home at the same time. At this sort of crucial point where you figure everything out for the first time, I think it can really have a transformative effect. That is why we see that paternity leave matters for a whole host of outcomes."     Episode Description: We begin by describing what paternity leave is and how it differs in countries worldwide. Richard's research documents the profound positive impact that fathers taking time off at the birth of a child has both in the short-term and long-term. Improvements in children's functioning have been noted up to 9 years after the leave. Regarding the 'selection question' - is it the leave or the father who chooses the leave - he is convinced that the data shows that the leave itself is a meaningful variable in these improved outcomes. We discuss the differential availability of leave between higher and lower-income workers and the relative absence of data on leave in same-sex marriages. We close with his sharing with us his personal story regarding paternity leave as well as the influence of how he was fathered in his own fathering.    Our Guest: Richard J. Petts, Ph.D. is a Professor of Sociology at Ball State University. His research focuses on the intersection of family, work, gender, and policy, with a specific emphasis on parental leave, father involvement, and workplace flexibility as policies and practices that can reduce gender inequality, promote greater work-family balance, and improve family well-being. He serves on the Board of Directors of the Council on Contemporary Families, an organization devoted to disseminating the latest research on American families. He has published extensively in academic journals, and his work has been featured in numerous media outlets including The New York Times, CNN, USA Today, The Wall Street Journal, and The Atlantic. You can learn more about his research by visiting his website www.richardpetts.com and by following him on Twitter, @pettsric 

"There is a company called NightWare, that developed a feature for PTSD that uses components from Apple Watch. One of the primary symptoms in PTSD is intense nightmares which are very distressing, they disrupt their sleep and really drive a lot of symptomatology. This company created an app that detects when people with PTSD are having nightmares.  It uses the existing sleep function [on the watch] to detect when they are having disruptive sleep. Then it uses the vibrating haptic to wake the patient up. So it is simply just disrupting their sleep, waking them up from a nightmare, and by doing so they have been able to show that they can decrease overall PTSD symptoms."      Episode Description: We begin with differentiating the application of technology in mental health evaluation and treatment. Isaac shares with us his research in measuring facial expressions as indicators of mood states with clinical implications for outcome prediction. He also discusses "natural language processing" and how this is in the early stages of applicability for mental health interventions such as suicide prevention. We consider the utility of wrist wearables and virtual reality as means to augment the clinician's tools to be attuned to patients' affects and experiences. We close with some thoughts on the future therapist's virtual office with Isaac sharing with us his professional journey in this world of mental health technology [Dr. Galatzer-Levy has no financial association with NightWare].     Our Guest: Isaac Galatzer-Levy, Ph.D. His work focuses on building mental health technology. He holds academic appointments at NYU School of Medicine in Psychiatry. Until recently, he led mental health technology development at Meta Reality Labs and now works at Google. Isaac’s career has focused on the development of biological and digital markers and accompanying digital interventions to remediate psychiatric illness, reduce risk, and promote resilience including the use of multi-omics data sources, computer vision, and voice analysis. He has published over 100 peer-reviewed scientific articles and is an inventor on multiple patents and continues to conduct research in industry, in collaboration with government entities (NIH, DOD, NATO, VA), and academics around the world, and contributes to large-scale open source/open science initiatives.   

"I would say to any parent who has a child now or any adult who has a disability now - disabilities are looked at quite differently. They are accepted much more than they were when I was growing up. So, you can’t take things out of context, but I was just living a secret life and that wasn’t good, it really wasn’t. That was why I was remote, so what I would do is dissociate when I felt the pain of being so different and I really paid a price for that. I am not sure there was any way to get through it, I was a successful child by other standards, but emotionally I was very damaged."     Episode Description: We begin with a description of Penny's childhood visual impairment and its impact on her early years. She recounts the "secret life" she felt she was living and her desperate wish to be like the other kids. Underlying, was a fear of being sent away to an institution if she revealed the full extent of her limitations. She recounts her lifesaving psychoanalytic treatment that helped her choose self-advocacy over victimhood. We discuss the sevenfold increase in sexual abuse in those who have disabilities, and she describes her own experience. She recounts her work as an occupational therapist and her recent onset of blindness now that she is in her 70s. We conclude with a quote from her final chapter on joy.    Our Guest: Penny Mishkin was born with a severe visual impairment which was diagnosed when she was two years old. She was a low-vision child with glasses and a blind child without. At age 12, she was fitted with contact lenses that allowed her to pass into the able world with 20/40 vision. Related to these experiences, Penny spent over 40 years as an occupational therapist. Two years ago, her luck ran out and she became legally blind. To find meaning and purpose in her new life, she has recently published a book entitled How I See It: A Personal and Historical View of Disability. She brings a unique perspective as a person with a disability and someone who chose a profession to help people with disabilities.