PTSD: Neurobiology Neurophysiologic Alterations in PTSD

PTSD: Neurobiology Neurophysiologic Alterations in PTSD

View more presentations from dominic54

Understanding PTSD and ASD

PTSD and ASD

View more presentations from Dawn-Elise Snipes

Intelligence is in the genes, researchers report

chicagotribune.com
By Eryn Brown, Los Angeles Times
August 10, 2011

Intelligence is in the genes, researchers reported Tuesday in the journal Molecular Psychology.

The international team, led by Ian Deary of the University of Edinburgh in Scotland and Peter Visscher of the Queensland Institute of Medical Research in Brisbane, Australia, compared the DNA of more than 3,500 people, middle aged and older, who also had taken intelligence tests. They calculated that more than 40% of the differences in intelligence among test subjects was associated with genetic variation.

The genome-wide association study, as such broad-sweep genetic studies are known, suggested that humans inherit much of their smarts, and a large number of genes are involved.

Booster Shots asked Deary to answer a few questions about the research. The following is an edited version of our questions and his emailed responses.

What exactly were you looking for when you looked at test subjects' genetic information?

We studied over 3,500 people. We looked at over 500,000 individual locations on the chromosomal DNA where people are known to differ. We looked at the association between those DNA differences and two types of intelligence. One type of intelligence was on-the-spot thinking (fluid intelligence) and the other was vocabulary (crystallized intelligence).

You wrote in your paper that 40% of the variation in crystallized intelligence and 51% of the variation in fluid intelligence is associated with genetic differences. How did you calculate those figures? And where does the rest of intelligence come from? Other genes, or environmental factors?

To estimate the proportion of variance associated with common genetic differences (in what are called single nucleotide polymorphisms, or SNPs) we used a new genetic statistics procedure invented by Professor Visscher and his colleagues in Brisbane, called GCTA. The rest of people's differences in those types of intelligence could come from genetic differences we were not able to capture, or from the environment.

Certainly, twin and adoption studies tell us that the environment makes an important contribution to intelligence differences throughout life, and especially in early childhood.

Is this the first time such a study has been attempted? How have scientists studied the relationship between genes and intelligence in the past?

There have been some studies looking at individual genes and sets of genes. And some smaller studies have been conducted with coarser genetic sweeps. This is the first study to use thousands of people, half a million genetic variants and to apply this new GCTA procedure to
estimate the genetic contribution directly from the genes.

Why would it be surprising that intelligence is an inherited trait? Many people might say this seems obvious.

It is not surprising to find that intelligence differences have some genetic foundation. Twin and adoption studies have been suggesting that for decades. But those studies make assumptions -- for example that the environment is just as similar for non-identical twins as for identical twins -- and people have questioned those assumptions.

Here, we bypass all that and test the DNA. What is not at all obvious is what the genetic contribution is. From our results, we can suggest that a substantial amount of the genetic contribution to intelligence differences comes from many, many small effects from genetic variants that are in linked with common variants (SNPs).

What parts of your study and analysis do you suspect might receive criticism, and on what grounds?

We don't point to individual genes among the 40%-50% of the variance we detected. We need far larger numbers to do that. We know now that it would be better to have ten times or more subjects than we tested.

We did not have exactly the same intelligence tests in each sample, so that might have led us to underestimate some effects. The GCTA procedure is not easy to understand, so it is hard for people to get their head round how the estimate for the genetic contribution is derived.

Autism, ADHD Share Genetic Similarities

Autism, ADHD Share Genetic Similarities
August 11, 2011 | MyHealthNewsDaily

Similar genetic changes found in some people with ADHD and in some with autism may help explain why children with the hyperactivity disorder often have symptoms of other developmental disorders, a new study reports.

The study identified several genetic changes that are present in a small portion of both attention deficit hyperactivity disorder (ADHD) patients and autism patients, and that are absent in people without these disorders.

Although it has been known that some autism and ADHD patients have certain rare genes in common, this is the first study "to compare the two conditions head to head, in an identical way," said study researcher Russell Schachar, senior scientist of psychiatry at the Hospital for Sick Children in Toronto.

In addition to finding a genetic overlap between the conditions, the study identified several genes not previously known to be involved in ADHD.

The research was published online Aug. 10 in the journal Science Translational Medicine.

Attention and autism
ADHD, a condition characterized by inattention, hyperactivity and impulsiveness, affects 4 percent of school-age children worldwide. Autism and its related disorders, whose symptoms include difficulty with social interactions and communication, affect approximately one of every 300 children. Scientists suspect that a combination of environmental and inherited factors leads to both conditions, but the specifics of the genetic pathways involved remain unclear, the researchers said.

Over the course of five years, the study researchers collected DNA and behavioral data from 248 children with ADHD and from 349 children with autism. Because these conditions can be misdiagnosed, the researchers first made sure the participants truly had them.

"We do one of the most painstaking kinds of assessments in ADHD literature," Schachar said. "It took essentially a day per participant."

The researchers analyzed the DNA of both groups of children, looking for a type of genetic change known as copy number variations (CNVs). In CNVs, a stretch of DNA includes a certain sequence repeated either too many or too few times. When the researchers compared the CNVs of ADHD patients with those of the autistic patients, they discovered several CNVs common to some members of both groups.

Twenty-two kids with ADHD had a CNV not found in healthy kids, and five of those kids had CNVs that also appeared in nine kids with autism, Schachar said.

"I would just characterize that as a modest amount of overlap, but overlap nonetheless," Schachar told MyHealthNewsDaily.

A link to other psychiatric disorders
"It's an interesting paper," said Dr. Joachim Hallmayer, associate professor of psychiatry at Stanford University who was not involved with the study.

But because Schachar's team found only a small number of instances of shared CNVs, Hallmayer said, "the big question is whether there are more of these rare alleles."

Schachar acknowledged that the number of ADHD and autism patients with these CNVs in common is small, but said it is still significant. The take-away message of the study is that "the genetic aspects of ADHD may be shared with other neurodevelopmental disorders, and we better figure out how that works," he said.

The specific find that Schachar called "most exciting" was the prevalence of mutations in the gene ASTN2, which is involved in the development of neurons. After discovering CNVs in ASTN2 in a few kids in both the ADHD and autism groups, the researchers further analyzed all the DNA samples from both groups of kids, and discovered other types of changes in that gene in eight more children with ADHD, and nine with autism.

These findings may indicate that disruption of this gene "is associated with a higher risk for neurophsychiatric disorder in general," the authors reported.

"Clearly these are genes that affect the development of the brain," Schachar said. But why changes in these genes "would be shaped into one disorder in one person and a different disorder in another person is going to be a question for a long time, I'm sure."

Existence: Where did my consciousness come from?

29 July 2011 by Anil Ananthaswamy
http://tinyurl.com/3h5ln4s

THINK for a moment about a time before you were born. Where were you? Now think ahead to a time after your death. Where will you be? The brutal answer is: nowhere. Your life is a brief foray on Earth that started one day for no reason and will inevitably end.

But what a foray. Like the whole universe, your consciousness popped into existence out of nothingness and has evolved into a rich and complex entity full of wonder and mystery.

Contemplating this leads to a host of mind-boggling questions. What are the odds of my consciousness existing at all? How can such a thing emerge from nothingness? Is there any possibility of it surviving my death? And what is consciousness anyway?

Answering these questions is incredibly difficult. Philosopher Thomas Nagel once asked, "What is it like to be a bat?" Your response might be to imagine flying around in the dark, seeing the world in the echoes of high-frequency sounds. But that isn't the answer Nagel was looking for. He wanted to emphasise that there is no way of knowing what it is like for a bat to feel like a bat. That, in essence, is the conundrum of consciousness.

Neuroscientists and philosophers fall into two broad camps. One thinks that consciousness is an emergent property of the brain and that once we fully understand the intricate workings of neuronal activity, consciousness will be laid bare. The other doubts it will be that simple. They agree that consciousness emerges from the brain, but argue that Nagel's question will always remain unanswered: knowing every detail of a bat's brain cannot tell us what it is like to be a bat. This is often called the "hard problem" of consciousness, and seems scientifically intractable - for now.

Meanwhile, "there are way too many so-called easy problems to worry about", says Anil Seth of the University of Sussex in Brighton, UK.

One is to look for signatures of consciousness in brain activity, in the hope that this takes us closer to understanding what it is. Various brain areas have been found to be active when we are conscious of something and quiet when we are not. For example, Stanislas Dehaene of the French National Institute of Health and Medical Research in Gif sur Yvette and colleagues have identified such regions in our frontal and parietal lobes (Nature Neuroscience, vol 8, p 1391).
Consciousness explained

This is consistent with a theory of consciousness proposed by Bernard Baars of the Neuroscience Institute in San Diego, California. He posited that most non-conscious experiences are processed in specialised local regions of the brain such as the visual cortex. We only become conscious of this activity when the information is broadcast to a network of neurons called the global workspace - perhaps the regions pinpointed by Dehaene.

But others believe the theory is not telling the whole story. "Does global workspace theory really explain consciousness, or just the ability to report about consciousness?" asks Seth.

Even so, the idea that consciousness seems to be an emergent property of the brain can take us somewhere. For example, it makes the odds of your own consciousness existing the same as the odds of you being born at all, which is to say, very small. Just think of that next time you suffer angst about your impending return to nothingness.

As for whether individual consciousness can continue after death, "it is extremely unlikely that there would be any form of self-consciousness after the physical brain decays", says philosopher Thomas Metzinger of the Johannes Gutenberg University in Mainz, Germany.

Extremely unlikely, but not impossible. Giuilio Tononi of the University of Wisconsin-Madison argues that consciousness is the outcome of how complex matter, including the brain, integrates information. "According to Tononi's theory, if one could build a device or a system that integrated information exactly the same way as a living brain, it would generate the same conscious experiences," says Seth. Such a machine might allow your consciousness to survive death. But it would still not know what it is like to be a bat.

Personality disorders category is likely to be dramatically revised for next psychiatry textbook

By Shari Roan, Los Angeles Times / For the Booster Shots blog

July 7, 2011

Several types of personality disorders will be dropped from the next edition of the Diagnostic and Statistical Manual of Mental Disorders. But one disorder previously proposed for elimination -- narcissistic personality disorder -- will likely remain in the text.

The American Psychiatric Assn. announced Thursday that the framework for personality disorders in DSM-5 will be a "hybrid" model that is substantially different from how personality disorders are diagnosed currently. Under the new system, personality disorders will be aligned with particular personality traits and levels of impairment.

The committee working on the personality disorders chapter of the DSM-5, which is due to be published in 2013, has proposed six types of disorders: antisocial, avoidant, borderline, narcissistic, obsessive/compulsive and schizotypal. They have proposed dropping paranoid, histrionic, schizoid and dependent personality disorders.

However, to qualify for a diagnosis, a patient would have to have a high level of impairment in two areas of personality functioning -- self and interpersonal. Patients would be assessed for how they view themselves and how they pursue their goals in life, for example, as well as how they get along with other people and whether they think about the consequences of their actions. The new model is less rigid than the existing diagnostic model. It is designed to reflect that behavior can change over time while personality traits tend to remain stable.

"In the past, we viewed personality disorders as binary. You either had one or you didn't," said Dr. Andrew Skodol, chairman of the DSM work group on personality disorders, in a news release. "But now we understand that personality pathology is a matter of degree."

The American Psychiatric Assn. also announced that a public comment period on DSM-5 proposals has been extended through July 15.

This article can be found at: http://www.latimes.com/health/boostershots/la-heb-personality-disorders-20110707,0,6126009.story

Idiot or Genius? Difference May Come Down to a Single Gene, Scientists Say

May 17, 2011 | FoxNews.com

Two genetic letters out of the 3 billion in the human genetic alphabet may spell the difference between a genius and an idiot, according to a new report.

A genetic analysis led by an international collaboration of scientists from the Yale School of Medicine determined that that tiny variation -- just two genetic letters within a single gene -- determines the intelligence potential or lack thereof of a human brain.

The report appeared online May 15 in the journal of Nature Genetics.

In normal brain function, convolutions, the deep fissures of the brain, increase the overall surface area, one of the primary determinants for intelligence. Deeper folds in the brain allow for rational and abstract thought, scientists believe.

In the latest finding, a team of researchers analyzed a Turkish patient whose brain lacks those characteristic convolutions in part of his cerebral cortex, a sheet of brain tissue that plays a key role in memory, attention, perceptual awareness, thought, language and consciousness.

The cause of this drastic cerebral deformity was pinned down to a gene called laminin gamma3 (LAMC3) with similar variations discovered in other patients with the same medical condition.

"The demonstration of the fundamental role of this gene in human brain development affords us a step closer to solve the mystery of the crown jewel of creation, the cerebral cortex," said Murat Gunel, senior author of the paper, co-director of the Neurogenetics Program and professor of genetics and neurobiology at Yale.

The folding of the brain is seen only in mammals with larger brains, such as dolphins and apes, and is most pronounced in humans. These fissures expand the surface area of the cerebral cortex and allow for complex thought and reasoning without taking up more space in the skull. Such foldings aren't seen in mammals such as rodents or other animals.

Despite the importance of these foldings, no one has been able to explain how the brain manages to create them. The LAMC3 gene may be crucial to the process.

"Although the same gene is present in lower organisms with smooth brains such as mice, somehow over time, it has evolved to gain novel functions that are fundamental for human occipital cortex formation and its mutation leads to the loss of surface convolutions, a hallmark of the human brain," Gunel said.

Poetry, film give voice for OCD sufferers

(CNN) -- "I'm edging towards being a recluse, but choose daily to fight for release from this crippling prison."

This is how Gemma Boyd describes her life with obsessive compulsive disorder, a mental illness marked by unwanted thoughts and repeated behaviors or rituals intended to reduce anxiety. She wrote these words in a poem last November, the first time she tried to deal with her daily struggles through creative writing.

Boyd, a 35-year-old British musician and poet, shared her poem online with Machine Man, an online forum where anyone with something to say about OCD can submit art, creative writing and multimedia projects, in addition to joining conversations about the condition. The forum is the online counterpart to a movie project called "Machine Man," both of which aim to spread greater awareness of OCD.

The film will aim to "get it out there what OCD really is, and take away some of the shame and stigma," said Kellie Madison, writer and director of "Machine Man."

It will portray a young man's struggle with OCD, showing how intense anxiety and compulsions quickly take over his life and prevent him from pursuing a relationship with the woman he loves. The script is complete, and production is still in the fundraising stages.

In the online forum, Boyd and others with OCD have found a safe space to express a part of themselves previously shrouded in silence. And they're energized by the prospect of a movie that would both represent their struggles and educate a wide audience about the disorder.

"I'm hoping that I'll be able to have a platform with this movie, and to try to really change my life around, because I have no choice but to do that," said Stephanie, a poetry contributor to the "Machine Man" forum who suffers from OCD, who asked that her last name not be used.

About 2% of adults in the United States have OCD, according to the National Institutes of Health. Across the ocean, where Boyd lives, about 1% of the United Kingdom's population is thought to have it, although this estimate is probably low, says the organization OCD-UK.

The illness often has an element of predisposition, meaning some people are more likely to develop it than others, said John Tsilimparis, an OCD therapist in Los Angeles. In fact, there is some evidence that people with OCD have distinct brain activity patterns. Stressful situations and traumatic events can trigger symptoms.

"I'm the architect still, I forgot how to draw. My healthy balance and perspective is a bit flawed. I'm OCD, tried for perfection for too many reasons," writes Stephanie in a recent poem called "My Frame".

For Boyd, 35, it was a traumatic event (which she'd prefer to keep private) that got her obsessively worrying about contamination about five years ago. But prior that, she had a mountain of bad memories from being sexually abused as a child that she'd repressed, and which also fueled her anxiety.

The intrusive thoughts started with a fear of blood. Over time they expanded; she became afraid of being attacked by men, any men, and could vividly imagine assaults even from male friends. In some of the worst periods, she couldn't leave her house because she kept checking and checking appliances, fearing a fire or home invasion.

"Relentlessly checking and re-checking numbers, magazine pages, text messages, household appliances -- everything -- causes my nerves to jangle 24-7: a gradual wearing down of brain function and twisting and twirling children who repeat and repeat aggravate my stifled anger," Boyd wrote in her poem.

To this day, she avoids many situations she used to enjoy so that she can avoid social contact: swimming pools, movie theaters, and restaurants.

"It's a battle against things which lots of people take for granted. I don't let it completely ruin my life, but it has made my life an uphill struggle," she said.

Crowds are out of the question -- unless, curiously enough, the people are listening to her play music. A professional musician, Boyd has found that the anxiety that restricts her in daily life isn't as bad when she's behind the double bass (her website lists six gigs lined up in May already). Music has been a sort of medicine, she says.

"When I'm performing, because I've got an instrument in front of me, I feel I'm protected a bit," she said. "When I'm in a normal situation, I feel as if I haven't got a skin."

As freely as OCD may be mentioned these days in popular culture -- a recent episode of "Glee" focused on it, for example -- Boyd had a tough time getting help near her hometown of Brighton and Hove, England.

She underwent several psychological assessments before receiving the diagnoses of OCD and post-traumatic stress disorder. Then she waited. And waited. It took about three years before she got to see a therapist who was supposed to be the best person in the area for OCD relating to sexual abuse. As it turns out, the therapist admitted that she didn't know much about OCD at all. Boyd stuck with her anyway for two years, but it only partially helped.

"I'm scared of opening up and then being told that there's no help available," she said. "Instead of seeking that help, I'll read the literature (about OCD), which isn't ideal."

Boyd has gotten some of her most critical OCD education through watching television and reading. The A&E program "Obsessed" taught her the difference between "obsession" and "compulsion," as well as the biological underpinnings of the disorder and various kinds of therapies.

A behavioral treatment shown to help people with OCD is called exposure therapy. Basically, the patient is forced to confront her fears -- for example, going out in public if she wouldn't normally, or letting time pass without checking to see if appliances were left on. The therapist systematically helps the person desensitize herself, Tsilimparis said. Psychiatrists may also prescribe drugs called selective serotonin reuptake inhibitors, which help depression as well.

Since Boyd's struggle with OCD has become more difficult recently, she's eager to investigate more OCD-specific treatment options in her country.

She does not take medication, and has decided against it for the time being. She has tried exposure therapy techniques on her own, but it's exhausting without support.

"You do need somebody to physically be there while you're experiencing these feelings, which I think can be pretty terrifying," she said.

On the bright side, Boyd has received positive feedback on her poem in the "Machine Man" forum, and some people have asked her to write more about it. She says she probably will.

"It's kind of helped me feel not so alone with my OCD," she said. "Hopefully, I've helped other people see they're not alone."

Osama bin Laden's death: How should we feel?

(CNN) -- You may be relieved or even ecstatic about the end of a symbol of terror, or maybe it seems like the pain is just beginning all over again.

Both of these reactions to the death of Osama bin Laden, who was killed by U.S. troops in Pakistan, are natural, experts say.

From the celebrations in Washington and New York, it looks like lots of people are happy. Chants of "USA! USA!" reverberated outside the White House and at New York's ground zero as crowds celebrated the death of the terrorist leader, President Obama announced Sunday.

As far as the collective American psyche goes, it makes sense that this is a moment of celebration, says Columbia University psychiatrist Dr. Jeffery Lieberman. The country has been experiencing emotional malaise, with a slow-moving economy, a sense of America losing its No. 1 status in the world, and a decade of pent-up anguish about the threat of terrorism. Much like the World War II years, these have been uncertain times.

Then, rumors of bin Laden's death, confirmed by an announcement from the president, lifted that burden of pain and helplessness.

"In the blink of an eye, the gloom and doom and pessimism has dissipated," Lieberman said.

After bin Laden: What does it mean to you?

But wait a minute: Should we rejoice in the death of another human being?

But although bin Laden claimed responsibility for the destruction of the World Trade Center and the deaths of thousands of Americans, the outpouring of celebration doesn't feel right for everyone.

David Sirota, a newspaper columnist and a contributor to Salon felt uncomfortable with the jubilation because he said there is a "difference between relief and euphoria."

"A euphoric response instead of somber relief suggests that we are celebrating revenge. We are not celebrating an end to the war," he said, comparing it to the public's euphoria when World War II ended.

"What's a little scary about this: We were once a country that saw violence as regrettable, but sometimes necessary act. But we're not celebrating end of violence, but the exercise of it."

Josh Pesavento, 22, a journalism student in New York who photographed the cheering crowds in Times Square on Monday morning, also felt conflicted about the celebrations he witnessed.

"I don't believe that any person has the right to kill anyone, and I don't think that we should be cheering for yet more loss of life. However, I tell myself that in this situation, these people may be cheering for the end of an icon who led to the death of far, far too many," Pesavento said.

For some, bin Laden represents an idea more than a person who lived and died. More than the death of a human being, this ends the life of a powerful symbol of terrorism and destruction, said Nadine Kaslow, psychologist at Emory University. Bin Laden's death hits closer to home in the U.S. than the capture and execution of Saddam Hussein, for example, because the Iraqi dictator did not directly attack American soil, she said.

The celebratory mood reflects a sense that fairness and justice had been restored and that a terrorist got his comeuppance, said Kaslow.

"I think people feel like this guy got what he deserved. It was a sense that it was 'our family' that was killed," she said.

But there are likely others who aren't chanting on the streets for whom the death of bin Laden brings back painful memories of the September 11, 2001, terrorist attacks, she said.

People who lost loved ones on September 11, 2001, may have symptoms of post-traumatic stress disorder, and the killing of bin Laden may open old wounds, Lieberman said.

"It doesn't bring their loved ones back. It doesn't ease their pain. There was so much more to this than catching bin Laden. At best, they would be bittersweet: It feels good to have the relief of this guy being gone, but the pain of their loss is very strong and very real to them," said Dr. Susan Nolen-Hoeksema, a Yale University psychologist.

Diana Massaroli, who lost her husband, Michael Massaroli, in the World Trade Center on September 11, 2001, said the news of bin Laden's death made her feel an "overall calm that I haven't felt in 10 years."

"I feel better ... like I can start a new chapter in my life."

Sirota and Kaslow likened bin Laden's death to the execution of a convicted murderer of someone's family, which may bring a sense of closure for some. In the case of bin Laden, though, there is fear of retaliation from terrorist groups.

"Relief also comes with a kind of sadness that the victims can never be brought back and sadness at the world that creates such a perpetrator," Sirota said.

Even people who didn't feel the direct impact of the attacks on September 11, 2001, will feel relief, Kaslow said. After all, everyone gets reminded of the global insecurity that resulted whenever they go to the airport.

The terrorist leader's living situation also doesn't bring about any sympathy -- he wasn't starving and struggling in a cave, but rather lived in a mansion, which adds to his perceived arrogance, Kaslow said.

The news of bin Laden's death "allows us to put some sort of order" to the horror of 9-11 because otherwise, "it's upsetting, disconcerting when we're reminded how unpredictable life, death and the world around us could be," said Sam Sommer, associate professor of psychology at Tufts University.

People's reactions are likely tied to how emotionally and personally they felt to the events 10 years ago, Sommer said.

"It seems to me that the emotional reaction had a lot to do with the differences in how people view this -- whether it's the right triumphing over evil -- a lot of young people are viewing this in that way," Nolen-Hoeksema said.

She noted that her teenage son and his friends were enthusiastically tweeting about the news in a tone that "this is a bad guy, the good guys got him finally -- that's all they are seeing." After, all Jack Bauer of "24" was trending on Twitter.

But the one common factor was that everyone felt a need to share the news and their observations -- whether it was rallying in front of the White House, or tweeting or updating their Facebook page.

"These emotionally charged events send us back to our social roots and make us need to affiliate with other people," Sommer said.

CNN's Nicole Saidi contributed to this report.

Do women like adult media and content as much as men?

By, Ian Kerner, a sexuality counselor and New York Times best-selling author.

If you’d asked me this question a couple of years ago, I would have said “no.” But the times they are a-changing: just as female infidelity is on the rise, women are catching up to the guys in other ways, too - including a propensity for porn.

As a sex therapist and founder of the website Good in Bed, here’s what I’m observing:

– More couples are enjoying porn together, with women often taking the lead in choosing the material.

– More women are using porn to get themselves in the mood for sex or to enjoy their sexuality on their own.

– More women are using porn to learn new sexual techniques or to explore sexually adventurous situations.

– More women are using porn to satisfy a general curiosity about sex overall, and

– More women are comfortable and confident in asserting their opinions on the subject.

In short, women are increasingly using porn for pretty much the same reasons (and pleasures) as men. Meanwhile, guys are increasingly surprised to discover that their female partners are interested in porn - and tend to be even more surprised to discover what they’re watching (I’ll get to that in a moment).

So what’s going on? Why the apparent change? To be honest, I’d always been of the mind that men and women are somewhat different when it comes to porn, for both biological and sociological reasons:

On the biological side, I’ve often said female sexual desire is more complex than male desire, and that porn rather clearly illustrates that difference: In men, visual stimulation leads quickly to sexual arousal, and with that chain of arousal often comes a desire to be stimulated to orgasm. In that sense, arousal and desire are very closely related, and it’s one of the reasons that Viagra has been so successful with men: Give a guy an erection and he basically wants to use it. In men, porn initiates the “sexual-circuit” very quickly.

That’s not to say that women don’t respond to visual stimulation either, or that that stimulation doesn’t lead to genital arousal, but that arousal doesn’t always trigger desire in women the way that it does with men.

When I talk to guys about their porn use, many describe a lack of pre-meditation. For example, a guy could be hanging out on his computer, checking out his favorite sports site, when up pops an ad with a sexy woman in a bikini and, bang, next thing he knows he’s trawling porn sites in search of sexual release.

With women, however, the use of porn or the desire/decision to have an orgasm is often less opportunistic. A woman may see something super-sexy, and recognize it as sexy, and even arousing, but that doesn’t mean she’s necessarily going to stop what she’s doing to stimulate herself to orgasm. (By the way, if you don’t agree with any of this, please chime in below in the comments - sexual desire is by no means a one size fits all model: everyone is different and topic of women and porn is a highly debated one.)

On a more sociological level, generations of women have been told that porn is evil: that it exploits, objectifies, and degrades women, and that a woman who enjoys porn is a betrayer of Women. Some may still feel this is true, (and there are plenty of women who feel uncomfortable with porn), but there are also plenty of women who would beg to disagree and look at porn as a fairly innocuous form of erotic escapism that’s a personal choice and not a big deal.

Additionally, many women have contended that porn, until fairly recently, was never really created with female customers in mind; that porn was designed to appeal to men and lacked elements that were more organic to female sexuality, such as foreplay, intimacy and erotic storylines.

Well, today there are many porn sites geared toward women. In fact, there’s even a regular Feminist Porn Awards that recognizes erotic entertainment that is smart, sexy, and appreciates women as viewers.

Combine a recognition of a female audience with the rapid proliferation of easily accessible Internet porn, and it only makes sense that more women are enjoying porn. (By the way, if you’re a woman and you’re interested in dipping a toe - or perhaps nose-diving - into the world of porn, I suggest checking out the work of Violet Blue and her book, "The Smart Girl's Guide to Porn." Or if porn isn’t your thing, but you’re interested in some hot erotic literature, take a look at the anthologies that are edited by Rachel Kramer Bussell.)

As it turns our women may be able to enjoy porn with less guilt, or at least with less grief from their male partners. In my experience, women tend to worry a lot more about their man’s porn habits and what it means to their relationship, whereas many of the men I’ve spoken with tend to be intrigued by the idea of women and porn - especially since women are much more likely to enjoy porn that does not directly reflect their sexual orientation.

One study at Northwestern University, for example, examined the effects of porn on genital arousal and concluded that men responded more intensely to porn that correlated to their particular sexual orientation, whereas women tended to be genitally aroused by a much broader spectrum of erotic material. Who knows –- perhaps the enormous variety of material offered by the Internet will end up playing more to the spectrum of female desire than male desire in the long run?

For the moment, it would seem that women are not watching porn nearly as much as men. Recently, a researcher from the University of Montreal set out to study whether pornography had an impact on guys’ sex lives. He searched for men in their 20s who'd never consumed porn, and guess what? He couldn't find a single one. I can still show you plenty of women who have never looked at porn - but perhaps not for long.

So do women like porn as much as men? You tell me.

Understanding what bipolar disorder is and how to diagnose if you have it.

Bipolar disorder involves periods of elevated or irritable mood (mania), alternating with periods of depression. The "mood swings" between mania and depression can be very abrupt.
Causes, incidence, and risk factors

Bipolar disorder affects men and women equally. It usually appears between ages 15 - 25. The exact cause is unknown, but it occurs more often in relatives of people with bipolar disorder.

Types of bipolar disorder:

People with bipolar disorder type I have had at least one fully manic episode with periods of major depression. In the past, bipolar disorder type I was called manic depression.

People with bipolar disorder type II have never experienced full-fledged mania. Instead they experience periods of hypomania (elevated levels of energy and impulsiveness that are not as extreme as the symptoms of mania). These hypomanic periods alternate with episodes of depression.

A mild form of bipolar disorder called cyclothymia involves less severe mood swings with alternating periods of hypomania and mild depression. People with bipolar disorder type II or cyclothymia may be misdiagnosed as having depression alone.

In most people with bipolar disorder, there is no clear cause for the manic or depressive episodes. The following may trigger a manic episode in people who are vulnerable to the illness:

Life changes such as childbirth

Medications such as antidepressants or steroids

Periods of sleeplessness

Recreational drug use

Symptoms

The manic phase may last from days to months and can include the following symptoms:

Agitation or irritation

Inflated self-esteem (delusions of grandeur, false beliefs in special abilities)

Little need for sleep

Noticeably elevated mood

Hyperactivity

Increased energy

Lack of self-control

Racing thoughts

Over-involvement in activities

Poor temper control

Reckless behavior

Binge eating, drinking, and/or drug use

Impaired judgment

Sexual promiscuity

Spending sprees

Tendency to be easily distracted

These symptoms of mania are seen with bipolar disorder I. In people with bipolar disorder II, hypomanic episodes involve similar symptoms that are less intense.

The depressed phase of both types of bipolar disorder includes the following symptoms:

Daily low mood

Difficulty concentrating, remembering, or making decisions

Eating disturbances

Loss of appetite and weight loss

Overeating and weight gain

Fatigue or listlessness

Feelings of worthlessness, hopelessness and/or guilt

Loss of self-esteem

Persistent sadness

Persistent thoughts of death

Sleep disturbances

Excessive sleepiness

Inability to sleep

Suicidal thoughts

Withdrawal from activities that were once enjoyed

Withdrawal from friends

There is a high risk of suicide with bipolar disorder. While in either phase, patients may abuse alcohol or other substances, which can make the symptoms worse.

Sometimes there is an overlap between the two phases. Manic and depressive symptoms may occur together or quickly one after the other in what is called a mixed state.
Signs and tests

A diagnosis of bipolar disorder involves consideration of many factors. The health care provider may do some or all of the following:

Ask about your family medical history, particularly whether anyone has or had bipolar disorder

Ask about your recent mood swings and for how long you've experienced them

Observe your behavior and mood

Perform a thorough examination to identify or rule out physical causes for the symptoms

Request laboratory tests to check for thyroid problems or drug levels

Speak with your family members to discuss their observations about your behavior

Take a medical history, including any medical problems you have and any medications you take

Note: Use of recreational drugs may be responsible for some symptoms, though this does not rule out bipolar affective disorder. Drug abuse may itself be a symptom of bipolar disorder.
Treatment

Spells of depression or mania return in most patients, in spite of treatment. The major goals of treatment are to:

Avoid cycling from one phase to another

Avoid the need for a hospital stay

Help the patient function as best as possible between episodes

Prevent self-destructive behavior, including suicide

Reduce the severity and frequency of episodes

The doctor will first try to determine what may have triggered the mood episode, and identify any medical or emotional problems that might interfere with or complicate treatment.

Drugs called mood stabilizers are considered to be the first-line treatment. The following are commonly used mood stabilizers:

Carbamazepine

Lamotrigine

Lithium

Valproate (valproic acid)

Other antiseizure drugs may also be tried.

Other drugs used to treat bipolar disorder include:

Antipsychotic drugs and anti-anxiety drugs (benzodiazepines), which can be used to stabilize mood

Antidepressant medications can be added to mood-stabilizing drugs to treat depression. People with bipolar disorder are more likely to have manic or hypomanic episodes if they are put on antidepressants. Because of this, an antidepressant is only used in people who are also taking a mood stabilizer.

Electroconvulsive therapy (ECT) may be used to treat the manic or depressive phase of bipolar disorder that does not respond to medication.

ECT is a psychiatric treatment that uses an electrical current to cause a brief seizure of the central nervous system while the patient is under anesthesia.

ECT is the most effective treatment for depression that is not relieved with medications.

Transcranial magnetic stimulation (TMS) uses high frequency magnetic pulses that target affected areas of the brain. It is most often used as a second-line treatment after ECT.

Patients who are in the middle of manic or depressive episodes may need to stay in a hospital until their mood is stabilized and their behaviors are under control.

Doctors are still trying to decide the best way to treat bipolar disorder in children and adolescents. Parents should consider the potential risks and benefits of treatment for their children.

SUPPORT PROGRAMS AND THERAPIES

Family treatments that combine support and education about bipolar disorder (psychoeducation) appear to help families cope and reduce the odds of symptoms returning. Programs that emphasize outreach and community support services can help people who lack family and social support.

Important skills include:

Coping with symptoms that are present even while taking medications

Learning a healthy lifestyle, including getting enough sleep and staying away from recreational drugs

Learning to take medications correctly and how to manage side effects

Learning to watch for early signs of a relapse, and knowing how to react when they occur

Family members and caregivers are very important in the treatment of bipolar disorder. They can help patients seek out proper support services, and help make sure the patient follows medication therapy.

Getting enough sleep is extremely important in bipolar disorder, because a lack of sleep can trigger a manic episode. Psychotherapy may be a useful option during the depressive phase. Joining a support group may be particularly helpful for bipolar disorder patients and their loved ones.

A patient with bipolar disorder cannot always reliably tell the doctor about the state of the illness. Patients often have difficulty recognizing their own manic symptoms.

Mood variations in bipolar disorder are not predictable, so it is sometimes difficult to tell whether a patient is responding to treatment or naturally emerging from a bipolar phase.

Treatment strategies for children and the elderly have not been well-studied, and have not been clearly defined.

Expectations (prognosis)

Mood-stabilizing medication can help control the symptoms of bipolar disorder. However, patients often need help and support to take medicine properly and to ensure that any episodes of mania and depression are treated as early as possible.

Some people stop taking the medication as soon as they feel better or because they want to experience the productivity and creativity associated with mania. Although these early manic states may feel good, discontinuing medication may have very negative consequences.

Suicide is a very real risk during both mania and depression. Suicidal thoughts, ideas, and gestures in people with bipolar affective disorder require immediate emergency attention.
Complications

Stopping or improperly taking medication can cause your symptoms to come back, and lead to the following complications:

Alcohol and/or drug abuse as a strategy to "self-medicate"

Personal relationships, work, and finances suffer

Suicidal thoughts and behaviors

This illness is challenging to treat. Patients and their friends and family must be aware of the risks of neglecting to treat bipolar disorder.
Calling your health care provider

Call your health provider or an emergency number right way if:

You are having thoughts of death or suicide

You are experiencing severe symptoms of depression or mania

You have been diagnosed with bipolar disorder and your symptoms have returned or you are having any new symptoms

References

Moore DP, Jefferson JW. Bipolar disorder. In: Moore DP, Jefferson JW, eds. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa: Mosby Elsevier;2004:chap 80.
Schiffer RB. Psychiatric disorders in medical practice. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa:Saunders Elsevier;2007:chap 420.
Benazzi F. Bipolar disorder -- focus on bipolar II disorder and mixed depression. Lancet. 2007;369:935-945. [PubMed]
Morriss RK, Faizal MA, Jones AP, Williamson PR, Bolton C, McCarthy JP. Interventions for helping people recognise early signs of recurrence in bipolar disorder. Cochrane Database Syst Rev. 2007;24;(1):CD004854. [PubMed]
Sachs GS, Nierenberg AA, Calabrese JR, et al. Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med. 2007;356:1711-1722. [PubMed]

7 tips for moving past a rotten childhood

Author Tracy McMillan knows a thing or two about getting over a bad childhood. Her father was a drug-dealing pimp and convicted felon who spent most of his daughter's life behind bars. Her prostitute mother gave her away.

Here's what she wants you to know about getting over your past.

1. Get a new story

There are two ways for me to look at my childhood story. In one, I'm a person who is so unloved and unwanted, my own mother gave me away.

In the other, I was born, took a look around at my prostitute mother and criminal father, and said to myself, "I can totally do better than this. Get your stuff, we're leaving." In one I'm a victim, in the other, I'm in power.

2. Realize blame = same

Blame is awesome. It feels good, right? It feels righteous. It feels powerful. It feels like someone's going to pay for what they did to you.

The only problem is -- as long as you're blaming -- nothing can ever change. Why? Because in order for your life to change, you have to want things to be different.

And if it feels good to blame, you have to admit that you like it. And if you like it, you have to admit that you don't really want it to change. Which is why blame just gets you more of the same.

3. Pretend you work at a retail store

Sometimes, I look at my bad childhood like it's an unruly customer and I'm working customer service the day after Christmas. It'll be acting up, moaning and complaining about how hard everything is, and how unfair it all is.

I just have to say to it, "Yes, I see you, ma'am. I know you have a problem. But right now I'm busy, so please have a seat. I''ll be with you just as soon as I can."

Then I do something productive that will actually change my situation, like go to work.

4. Accept the fact that some don't really want you to succeed

This sounds harsh, and it is. But it's true.

Some of your family and friends "support" you by cosigning all your b.s. about how hard you have it, because if you succeed, two things will happen:
1) You will leave. And 2) They will be left behind.

This doesn't mean you have to get rid of your friends and family, you just have to remember that they love you so much, they're perfectly happy for you to stay exactly where you are right now.

5. Decide to KSA (Kick some ass)

When my 13-year-old said he hated science class, I told him that getting a 95 on the test was the equivalent of getting in the face of his least favorite teacher and saying, "Have some!"

In other words, kicking ass on the test is just like playing a video game. Needless to say, he's getting As now. Channeling your anger will get you a long, long way in life.

6. Hoard your money

The number one way to end your bad childhood is to save money. I have a very simple rule about money: If I never spend everything I make, I will always have money. And money is power.

All those commercials you see are a big, rich company's attempt to get you to give them your power. Don't do it! Think of every dollar you save as one step away from the people and places that have kept you down.

7. Get a paper route

In fifth grade, I wanted a 10-speed bike like all the other kids had. So I started delivering papers when I was 11. In Minnesota. In the winter.

Compared to that, every job I've had since has been easy. While there may not be papers to deliver in the snow, the point is to do the thing you don't want to do.

Get a hard/crappy job and do it until the voices in your head stop telling you that you can't take it another minute. Everything after that will be cake, and your bad childhood will be over. I promise.

Sexual side effects: A silent epidemic?

By, Ian Kerner

Are meds zapping your mojo? Is a prescription inhibiting your passion? If so, you’re far from alone. More than 27 million Americans take antidepressant drugs and research suggests that 37 percent of those people experience sexual side effects. And that’s just in the category of antidepressants! When you consider that millions of drugs are prescribed for common medical conditions, such as high blood pressure, and that many of those drugs can lead to sexual dysfunction of some sort, it’s no wonder that nearly 40 million Americans describe themselves as being stuck in sexless marriages. Many of us may be grappling with a sexual problem and not even realize that a drug or drug combination could be the underlying cause. In this sense, sexual side effects could be a silent epidemic.

But for many people going off their medications simply isn’t an option. In the case of antidepressants, most people who take them are actually happier than they were before they went on the drugs, and while they may be dealing with sexual side effects such as erectile disorder or loss of desire, they weren’t necessarily interested in sex before the medication either. “After addressing your depression, anxiety, or other mental health concern, you're interested in sex again—enough to worry about how the medication is affecting your sex life,” explains my Good in Bed colleague, psychiatrist Dr. Ed Ratush. “You may be bothered by what you think is a lower sex drive, but consider how you felt before. In a way, your libido has actually increased!”

Sexual side effects don’t have to destroy your sex life, but they may mean that you have to change your approach to sex. In the case of low desire (a very common sexual side effect), you may have to put your body through the motions in order to get your mind to follow. Or you may have to spend a lot more time on foreplay and getting yourself physiologically aroused. Ratush suggests trying a sexual warm-up, a technique that helps generate arousal but intentionally does not lead to climax or ejaculation. “The idea is that the process of getting aroused will increase the person's ability to generate more of the sex hormone testosterone later in the day or later in the week,” he says.

And remember that mental stimulation plays a big role in sexual arousal, so you may have to try some new things and develop some new routines.

What are some other things you can do?

• Talk to your doctor. Sounds simple enough, but many people are uncomfortable talking about sex with their doctors and, believe it or not, many doctors are uncomfortable as well. Not all doctors are adequately trained in human sexuality, and many don’t take the time to discuss all of a patient’s needs. It can be challenging to start a conversation about sex, but it’s worth it: Your doctor may be able to switch you to a similar medication with fewer side effects. Some people find that switching from Celexa to Lexapro, for example, helps treat their depression without affecting their sex life.
• Reduce your dose. It’s possible that you can still achieve benefits of medication, but at a lower dose that may not induce sexual side effects.
• Have sex at a different time. Sexual dysfunction may be significantly higher two hours after a dose of medication and may be less problematic two hours before the next scheduled dose, so time your rendezvous accordingly. Or have morning sex: Testosterone levels are generally highest in the morning and decline throughout the day.
• Add a sexual enhancer. Some medications can improve excitement by increasing either desire or blood flow. In the case of erectile disorder, for example, a physician may prescribe a medication such as Viagra, or in the case of low desire he or she may recommend a drug like Wellbutrin. It may sound a little strange to deal with the sexual side effects of one drug by adding another, but under the supervision of a physician who is familiar with your medical history, drugs can be combined in creative ways.
• Focus on diet and exercise. Your lifestyle and overall fitness plays a big role in your sexual health. For example, many people end up gaining weight once they go on an SSRI antidepressant, which also contributes to low libido and erectile disorder.

Dealing with sexual side effects can be tricky and frustrating, but the point is to not just give up. Go on the web and do some research. Be proactive in communicating with your doctor and your partner. Try new things in the bedroom. When you have to say “yes” to drugs, don’t say “no” to sex.

Too Old To Hold

This summary is not available. Please click here to view the post.

To the brain, getting burned, getting dumped feels the same

(Health.com) -- Science has finally confirmed what anyone who's ever been in love already knows: Heartbreak really does hurt.

In a new study using functional magnetic resonance imaging (fMRI), researchers have found that the same brain networks that are activated when you're burned by hot coffee also light up when you think about a lover who has spurned you.

In other words, the brain doesn't appear to firmly distinguish between physical pain and intense emotional pain. Heartache and painful breakups are "more than just metaphors," says Ethan Kross, Ph.D., the lead researcher and an assistant professor of psychology at the University of Michigan, in Ann Arbor.

Health.com: How to keep chronic pain from straining your friendships

The study, which was published in the journal Proceedings of the National Academy of Sciences, illuminates the role that feelings of rejection and other emotional trauma can play in the development of chronic pain disorders such as fibromyalgia, Kross says. And, he adds, it raises interesting questions about whether treating physical pain can help to relieve emotional pain, and vice versa.

"What's exciting about these findings," he says, "is that they outline the direct way in which emotional experiences can be linked to the body."

Kross and his colleagues recruited 21 women and 19 men who had no history of chronic pain or mental illness but who had all been dumped by a romantic partner within the previous six months. The volunteers underwent fMRI scans -- which measure brain activity by tracking changes in blood flow -- during two painful tasks.

Health.com: 6 mistakes pain patients make

In the first, a heat source strapped to each subject's left arm created physical pain akin to "holding a hot cup of coffee without the sleeve," Kross says. In the second, the volunteers were asked to look at photos of their lost loves and were prompted to remember specific experiences they shared with that person.

Other fMRI research has examined how social rejection manifests in the brain, but this study was the first to show that rejection can elicit a response in two brain areas associated with physical pain: the secondary somatosensory cortex and the dorsal posterior insula. Those brain regions may have lit up in this study but not others because the rejection his volunteers experienced was unusually intense, Kross says.

Although Kross stresses that the study is "very much a first step" in understanding the connection between physical and emotional pain, the findings may help chronic pain patients grasp that emotions can affect their physical condition, says psychologist Judith Scheman, Ph.D., director of the chronic pain rehabilitation program at the Cleveland Clinic.

Health.com: Is chronic pain ruining your relationship?

Past traumas can make people more sensitive to pain and thus more susceptible to disorders like fibromyalgia, which causes both chronic pain and fatigue, Scheman says. She and her staff encourage pain patients to "explore their emotional trauma and baggage," but many are reluctant to do so.

"As a clinician, I like studies like this because patients often don't understand why they have to do painful emotional work," Scheman continues. "Showing them something like this helps them understand that there is science behind what I am asking them to do."

http://www.cnn.com/2011/HEALTH/03/28/burn.heartbreak.same.to.brain/index.html?hpt=C2

Birthday-suit therapist Sarah White conducts naked therapy sessions for troubled New Yorkers

Birthday-suit therapist Sarah White conducts naked therapy sessions for troubled New Yorkers

BY Rich Schapiro
DAILY NEWS STAFF WRITER
http://tinyurl.com/4r8hjw9

Wednesday, March 2nd 2011, 4:00 AM
Sarah White, a 24-year-old psychology buff, conducts therapy sessions during which she progressively removes her clothing. Above, she counsels a News reporter about work-life balance.

Sarah White, a 24-year-old psychology buff, conducts therapy sessions during which she progressively removes her clothing. Above, she counsels a News reporter about work-life balance.

There's one sure way to get a man to bare his soul - get naked.

Sarah White, a 24-year-old psychology buff, conducts online therapy sessions in her birthday suit. The naked therapist's unique approach to helping people solve their issues has, she says, aroused interest from dozens of suffering New Yorkers.

"For men especially, who are less likely than women to go to therapy, it is more interesting, more enticing, more exciting," said White. "It's a more inspiring approach to therapy."

White begins her sessions with her clothes on. But as the hour-long appointments heat up, she gradually sheds all of her duds until there's nothing left to take off.

"Freud used free association," she said. "I use nakedness."

The initial sessions, which cost $150, are conducted via a one-way Web cam and text chat. Once she develops a rapport with a client, she'll move on to two-way video appointments via Skype and even in-person consultations.

White said her roughly 30 clients are an eclectic mix of college students with sexual issues, middle-aged men with relationship problems and even a couple of women who just enjoy chatting with a nude peer.

Clients schedule appointments through her website, sarahwhitelive.com.

A freelance computer programmer, White said she got the idea to perform therapy sessions in the nude after being uninspired by the theories she learned as an undergraduate psychology student. She conceded that naked therapy is not approved by any mental health association. And she is not a licensed therapist.

White demonstrated her less-is-more style yesterday, slowly peeling off layers of clothing as she counseled a Daily News reporter on seeking a better work/life balance.

"It sounds like you're not sure if this is really a problem," White said shortly before removing her teal bra.

While White's boyfriend supports her new business, her parents are still in the dark.

"I should probably tell them before they read it in the paper," said White, of the upper West Side.

Not surprisingly, professional psychologists are not sold.

"She's using the word therapy here, but I don't consider this therapy," said Diana Kirschner, a New York-based clinical psychologist. "I consider this interactive soft-core Internet porn."

Kuamell Johnson, 31, said he'd love to experience a therapy session with White, but he's not sure he'd be able to stay on topic.

"She starts to strip, now she's butt naked," pondered Johnson, a messenger from Brooklyn. "It's going to throw my concentration off."rschapiro@nydailynews.com

Funeral for coffin dwellers dying to live (Suicidal people in Seoul volunteer to be 'buried alive' in effort to regain will to live)

By Paula Hancocks, CNN

Seoul (CNN) -- Kim Byong-soo steps out of his shoes and into his coffin. He slowly lies down and closes his eyes. It is minus 11 degrees Celsius in these South Korean woods, but Kim doesn't seem to feel it. His hands and feet are tied. Only then does he open his eyes as the lid is closed and hammered down.

This "death" is Kim's last chance to regain his will to live.

For 15 years, this highly successful Seoul-based dentist has wanted to kill himself. "Every day I want to turn a gun on myself," he says. "Every moment I'm awake. I think about suicide daily but I can't do it because I have too many responsibilities."

Kim enrolled in the Beautiful Life seminar with the hope it will change his mind. It's a radical technique to help people forge a fresh outlook on life and its founder Kim Giho says that only by dying can some people find their desire to live.

"We can't understand death simply by talking about it. People truly experience death by participating in it and being reborn with a pure state of mind." Kim Giho tries to demystify death by talking about it directly with the group.

As part of his treatment, the dentist has to write a suicide letter, his final words to his wife and children. Writing by candle-light, Kim scribbles furiously.

Earlier he said of his wife: "She knows that I'm having a hard time, but she doesn't know that I want to kill myself and I don't ask her for help. If I do, it will be too hard for her."

Kim is then dressed in traditional burial clothes -- loose fitting hemp cloth -- and taken out into the snow. Along with five others in the group, he is led by a man dressed in black, symbolizing death.

In a small badly lit clearing in a wooded area of Seoul, six coffins have been laid out. Kim kneels next to his, lowers his head and listens as a final prayer is given. This is his funeral.

Then, in silence, he steps into the wooden coffin and lies down. Kim Byong-soo stays in the coffin, seeing and hearing nothing, for 20 minutes.

Kim Giho says this sense of being 'buried alive' can reboot a suicidal mind. He tells me some people re-emerge into the fresh air with tears streaming down their faces, promising a determination to live every day to the full.

When Kim rises from his coffin, there are no tears and he says nothing.

Once back inside the seminar room he re-reads his suicide letter intently. He adds to his letter to his wife and children and tells the group: "Starting tomorrow, I don't want to be that person who just used to eat and work to get by. I want to love others, know how to forgive others and have hope."

Talking about his wife, he says: "Whatever you want I will do it for you."

Just hours after saying that he wants to die, Kim is making plans to take his wife on a holiday.