We're Only Human

When I read about the recent government-sponsored study of mental illness, I wasn't surprised. It indicates that half of all Americans will, at some point in their lives, meet the criteria for mental illness (which includes substance abuse), and that those problems are starting at younger ages. I'm well aware of the argument that these rates must be exaggerated, but as a clinical psychologist, there is no doubt in my mind that there has been a real increase in the number of mood and anxiety disorders during the 20-plus years I have been in practice.

I believe I know one reason. As I listen to my patients and to the stories other therapists tell, it is clear that technological change -- the blessing and curse of our era -- has led many of us to tax the human body and psyche in ways that our species has not had time to accommodate. Not only do adults, adolescents and even little kids have so much activity crammed into the course of a day that it's tiring just to hear them talk, but each generation is experiencing the world quite differently from their parents and grandparents.

The scale of that change came home to me last week, when Jack Kilby, inventor of the microchip, died. Putting his achievements into perspective, the chairman of Texas Instruments said that "there are only a handful of people whose works have truly transformed the world and the way we live in it -- Henry Ford, Thomas Edison, the Wright brothers, and Jack Kilby."

Just think about that statement. Those men's innovations "transformed the world and the way we live in it ." It's as if we have forgotten the lesson that Charles Darwin taught us: Evolution and biological adaptation take time, usually long periods of time. Yet people seem to assume that we can keep the pace the machine has set. (Remember Charlie Chaplin going round and round, caught in the gears of a giant machine, in his satire "Modern Times"?) Many of the patients I see reveal just how much we've overestimated our flexibility and underestimated the price we pay for how we live in these modern times.

Ever since the first electric bulb shed artificial light, we have been detaching ourselves from our natural rhythms. Business travelers cross time zones and go right back to work; adults extend their hours by bringing work home with them; teenagers contact their friends anywhere at any time of the day or night. Until, that is, they end up in therapists' offices having been stopped in their tracks by physical or psychological dysfunction. Many blame themselves when things go wrong. They minimize the impact of our super-charged environment on their psychological well-being.

It's hard to believe that not long ago, most people actually went to bed when the sun went down and got up when the sun came up. They were born, lived and died within short distances of their childhood homes. They communicated face to face most of the time, or else by letter or telegram. Theygathered frequently at home, in places of worship and in civic organizations.

Even the movers and shakers kept to a saner schedule. In her book "No Ordinary Time," historian Doris Kearns Goodwin describes President Franklin D. Roosevelt's daily schedule. It included eight hours of sleep a night, and an evening cocktail hour when he gathered with friends to talk, laugh and relieve the pressures of the day. President Bush was the butt of his wife's jokes for keeping a similar schedule. Neither exemplified the lives described by many of my patients who work in government, law firms, medical practices and businesses in the D.C. area. With longer work weeks and commutes, they have fewer of the quiet restorative moments that nature requires to recharge and renew.

From depressed patients, therapists frequently hear about symptoms that psychiatrists term "vegetative." These concern the most basic biological functions, including sleep; appetite, for food as well as sex; and enjoyment. My children's babysitter, just back from a two-week vacation, once described her own restoration succinctly: "I feel good in my body." Too many people today do not know what it means to feel good in their bodies.

Part of the problem is simply lack of sleep. I sometimes fantasize that if I had a magic wand and could ensure that everyone would sleep eight hours a night, visits to therapists would drop by, perhaps, a quarter. Sleep -- particularly REM sleep and dreaming -- helps discharge tensions, restore energy and rebuild a foundation for stable functioning. I heard a lecture during my student days in which a psychiatrist said, "It is unclear whether depression is primarily a disorder of mood, or primarily a disorder of sleep." People who are sleep-deprived for any length of time are out of whack. Once sleep is seriously disordered, it can be difficult to restore the normal circadian rhythm essential to well-being.

I can think of a successful young couple with demanding jobs who found out the hard way. They fully expected to take the demands of children in stride, as well as a move to a new home. In time, the wife developed major depression with serious sleep disruption when child-care problems became for her the proverbial last straw. Only then did they wake up to the forced march their lives had become.

Another modern problem is when people sleep. Early to bed and early to rise really is a good idea, because it maximizes light exposure, which in turn boosts mood. Factories have largely stopped scheduling shifts with employees working days, then afternoons, and then nights at two-week or monthly intervals, because of the resulting physical and psychological strain.

Every summer, I talk with the mood-disordered teenagers who are heading off to college about trying to go to bed early and get up early as a hedge against depression. Students on so-called "college time" are without a doubt the most intransigent group when it comes to decent sleep habits. (My oldest child, newly home from college one summer, asked her father and me why we were going to bed so early -- at midnight.)