Why Antidepressants Don't Work

Diagnosing Depression

You go to the doctor complaining that you don't feel like yourself.  You aren't having fun, you are tired, you don't sleep well, you have no appetite and feel pretty worthless about your inability to exercise control over anything in your life.  Sometimes you feel like just ending it all.

Your doc asks whether you have a plan (sometimes you think about how you might do it), if anyone in your family has bipolar (not that you know of) and checks your thyroid and glucose levels.

DSM On Depression -- The Chinese Menu

But before the blood tests come back, your doc has already checked the magic list from the Diagnostic and Statistical Manual of Mental Disorders:

Column A:

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

Column B:

3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.

4. Insomnia or hypersomnia nearly every day

5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

6. Fatigue or loss of energy nearly every day

7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Ding, ding, ding.  One from Column A, four from Column B. (Your weight loss has been too gradual to count.)  That is all the doc needs to write out a prescription for an antidepressant.  Zoloft is the latest favorite, being the newest.  But if your drug coverage is lousy, you get fluoxetine -- Prozac in its non-generic incarnation.

Depression As A Chemical Imbalance?

You are not sure you want to take an antidepressant.  But your well-educated neighbor assures you that there is no shame in it.  It's not your fault.  Depression is a chemical imbalance in the brain, and antidepressants fix the imbalance.
 

I call this the chemical stew theory.  Your brain is too bland.  Add some salt and you will be good to go.

What a great marketing technique.  It's simple.  It's morally neutral.  It's even kinda manly, if that's an issue for you -- chemistry, you know.  And your next door neighbor, whose education comes from TV ads, is part of a sales force which has been so effective that one out of every ten people in the United States of America is taking an antidepressant right now.

Too bad it hasn't worked out.

No -- Antidepressants Do Not Fix A Chemical Imbalance

There are a couple reasons (at least) why adding a chemical to the stew does not solve the chemical imbalance.

The first reason is that your brain is not a stew.  If you like the food metaphors (and as you can see, I like the food photos), adding a chemical to your brain is more like adding it to a souffle.  The chemical balance in your brain is finely tuned to a variety of interacting factors.  Changing one of the factors has multiple effects, not all of them intended, and not all of them so good for you.

For example, a souffle has fat in it.  Maybe the problem with your souffle is not enough fat.  But when you mix fat into the egg whites, the whole thing falls flat.

The second reason antidepressants fail to do their intended job is that they do not address the problem at the right location. The theory suggests you can fix the imbalance by increasing the serotonin in your synapses.  But scientists have figured out the problem occurs farther upstream.

Or at least that is what the scientists say who fund their labs with money from the pharmaceutical companies who still want to add a chemical to your brain, just maybe a different chemical than the ones whose patent protections have expired.

The Brain As Machine

The new meds are not going to work either, because they are working with, not a food, but a mechanical metaphor.  So second millennium!

Like this:



If only they can find the right place to change the course of the inevitable falling blade?  I don't think so.  Your brain is not a machine.

The Brain As A Living System

Here we go:

Your brain is a whole world.  Those who would tinker with it need to understand its ecology.

Put the internal combustion machine onto this planet, and the whole rest of it experiences the consequences.

Block serotonin from reentering your neurons, and your tear ducts and intestines dry up.  And your sex life.  Put enough of us on antidepressants and we could become an endangered species.

So if you want to do something about depression, if you have it or love anybody who has it, then you have to pay attention to the ecology.  Your interventions will have complex consequences.

And -- this would be a third reason and most intractable reason why antidepressants don't work -- the planet/body/brain/ecosystem is always working to restore balance to the system.  Up the serotonin in your synapses and eventually another part of the brain adjusts to overcome your interference.  In ecology this phenomenon is called homeostasis.  Psychiatry calls it Prozac Poop-out.

I kept complaining about insomnia, one of my Chinese menu choices that did not go away.  A psychiatrist told me my symptoms were caused by my depression.  Address the underlying depression and eventually the symptoms would be relieved.  Never mind about the symptoms that replace them.  Those symptoms are not on the depression menu, and have nothing to do with the psychiatrist.

A Twenty-First Century Approach To Depression?

But systems theorists tell us that any intervention will move the whole rest of the system.  This works in the environment, the economy, the workplace, the family dinner table.  And in the brain.

So what if we go back to that menu and devise some interventions that are not the equivalent of a chemical sledge hammer?

That brings me back round to last week's post about insomnia, when I promised that the next installment of my sleep series would be:

The Good News About Sleep Deprivation and Suicidality 

The good new is coming next -- implications for treatment of mood disorders and other causes of suicidal thoughts and behavior.

It just took me an extra week to get there.  So what else is new.  It's a Prozac Monologues series.

photo "Loneliness" by  Graur Razvan Ionut, from FreeDigitalPhotos.net 
photo of Chinese menu by Hoicelatina, permission to copy under the terms of the GNU Free Documentation License 
photo of bell by Salvatore Vuono from FreeDigitalPhotos.net 
representation of serotonin in public domain 
 photo of pote asturiano by jlastras and used under the Creative CommonsAttribution 2.0 Generic license 
photo of chocolate souffle by Akovacs.hu at the wikipedia project, who has released it to the public domain
representation of lactic acid in public domain
NASA photo of the Earth in public domain
photo of Anthia goldfish in public domain

More on Sleep and Mental Illness

Last week's post on postpartum depression and sleep led me to a ring of articles about the link between sleep and mood.  So here we go again -- I have stumbled on another series!

My opening shot is piece my son and I used to watch from a Sesame Street bedtime video.  If it inspires you to go take a nap, that's fine by me.  You can read this post later.



Only, one line isn't correct.  It really doesn't matter, don't you know it's so.  'Cuz you sleep in so very many ways.

Sleep Matters

It does matter.  That guy yawning over his book might have pulled an all-nighter.  If he does that often, or stays up late, or changes shifts, he might be sleep-deprived.  Which puts him at risk for depression and suicidal thoughts.

Really.

Not to mention that goose egg.

What Is Suicidality

The studies I will be citing refer to suicidality.  So let's start by defining that term.  Actually, the word is used loosely, refering to a range of behaviors, in some places as the intent or attempt to kill oneself, in other places as anything from occasional thoughts to attempts.  Any of which is unpleasant, much of which is terrifying.

Suicidality And Depression

Doctors used to think that only people who were depressed committed suicide.  If somebody with schizophrenia committed suicide, they concluded that the diagnosis had been in error, because people with schizophrenia don't commit suicide.  So the theory went.  Notwithstanding what you have been taught about people who call themselves scientists, even in science it is easier to change your facts than to change your mind.

The general public still tends to accept that idea, suicide=depression.  When somebody they know commits suicide, the assumption is that they missed the signs of depression.

The vast majority of those who commit suicide are depressed.  However, not necessarily so.  People who have other mental disorders, or are in chronic pain, or have been diagnosed with a terminal illness, or have suffered a failure or humiliation, or just too many things and finally one thing too many are all at risk.  As David Conroy explains, Suicide is not chosen; it happens when pain exceeds resources for coping with pain.  Whatever the pain. 

Suicidality As The Tip Of The Iceberg

The Diagnostic and Statistical Manual of Mental Disorders (DSM -- psychiatry's bible) lists suicidal thoughts and behavior as just one symptom in their Chinese menu approach to depression -- one from column A, five from columns A and B.  You don't have to be suicidal to get the diagnosis.  But it is the symptom that really gets their attention.

If you have suicidal thoughts or behavior, then something is going on.  The odds are depression, but at least something.  And obviously, it's not fun.  So it is worth addressing, before it sinks your ship.


Sleep Disturbances And Suicidality

So here is a study that discovered, whatever else is going on in your life -- insomnia more than doubles your risk of suicidal thoughts, planning, action.

It doesn't matter whether you have depression, anxiety disorder or other mood disorders, or chronic medical conditions such as stroke, heart disease, lung disease and cancer.  It doesn't matter whether or not you are abusing drugs or alcohol.  Age, gender, and marital and financial status don't matter.  All of these are risk factors in themselves.  But whatever risk factors you may or may not have, insomnia more than doubles your risk of suicidal thoughts, planning and/or action.

Insomnia comes in three flavors in the medical world: trouble falling asleep, waking in the middle of the night, and waking too early in the morning.  The last has the greatest risk.

Irregular Bedtime And Suicidalality

There are other studies that examine particular applications of the poor sleep/suicidality connection.  Here is one that examines what happens to young adults when they don't go to bed at the same time every night.

The Florida State University Laboratory for the Study of the Psychology and Neurobiology of Mood Disorders, Suicide, and Related Conditions discovered that actively suicidal undergraduates got an average of 6.3 hours of sleep a night -- way not enough sleep.  This we could anticipate.

Then they examined another factor, how much their bedtimes varied -- an average 2.8 hours.  For example, they might go to bed some nights at midnight, other nights at 3 AM.  So they sorted subjects by the second factor, how much bedtime varied.  Regardless of the severity of an individual's depression, the more variable the bedtime, the more suicidal the student became over the course of three weeks.

Get that?  All by itself, how much bedtime varied, all by itself, predicted increasing suicidality.

Varied bedtime also predicted the intensity of mood swings.  Which is significant, because suicide is associated with mania as well as with depression.  Both are indicators of poor cognitive function and poor impulse control.

Not to mention a bad report card.

Adolescent Bedtimes And Suicidality

So here is one more, this one on teenagers.  (Teen do not have the highest suicide rates.  But they do seem to get the most press and the most research dollars.)

James Gangwisch, PhD, of Columbia University studied the sleep habits of 15,659 teens.  He reports that teens whose parents enforced a midnight bedtime were 24% more likely to have depression and 20% more likely to have suicidal thoughts than teens whose parents enforced a 10 PM bedtime.

The 10 o'clockers got an average of eight hours and ten minutes of sleep at night, compared to seven hours and thirty minutes for the midnight crowd.  Both were short of the nine hours that teenagers need, which would account for the general crankiness of most teenagers you know or are.

Oh, and that Nobody else's parents make them... argument?  More than half of parents enforce the 10 PM bedtime.  And 70% of teens comply.

I didn't find a study on the relationship of sleep and report cards.  But some scientists surmise from this and other studies that sleep deprivation may be the real reason for the United States' slip in global competitiveness.

The Good News About Sleep Deprivation and Suicidality

The good new is coming next -- implications for treatment of mood disorders and other causes of suicidal thoughts and behavior.

Now get off the computer and go to bed.

photo of scales from Deutsche Fotothek of the Saxon State Library

 photo of Chinese menu by Hoicelatina, permission to copy under the terms of the GNU Free Documentation License

photomontage of iceberg created by Uwe Kils (iceberg) and User:Wiska Bodo (sky), permission to copy under the terms of the GNU Free Documentation License

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The Insomnia Cure for Postpartum Depression -- AKA Stupid Science Reporting

My niece just gave birth to twins, and friends are bringing home their newborn.  So this report on sleep deprivation is personal.

Last year's Best of Stupid Science Reporting comes from (drumroll, please...) the New York Times: In Sleepless Nights, a Hope for Treating Depression by Terry Sejnowski.

Don't Believe Everything You Read In The New York Times

Evidently, 75 published papers with over 1700 subjects in the last forty years have documented that the depressive symptoms of new mothers are relieved after a sleepless night.  Now let's remember the number one rule of research publishing -- for all we know, the same study may have been published 75 times.

On the other hand, if the author didn't double count studies, that would be an average of 23 participants per study.  Whatever the results, with those numbers, they would not be robust results.  A review of literature cited below examined some of these studies.  One had nine participants.  One had three.  These are not studies.  They are anecdotes.

Sleep Deprivation And Euphoria

Moving on.  Anybody with bipolar disorder or for that matter, any student who has pulled an all-nighter can tell you that sleep deprivation lifts mood.  After we talked until 5 AM my freshman year, the most natural thing to do in the world was to go invade a nearby garden and pick somebody's blackberries. 

Sleep deprivation used as a treatment for depression is efficacious and robust: it works quickly, is relatively easy to administer, inexpensive, relatively safe and it also alleviates other types of clinical depression, Sejnowski reported.

Unfortunately, There Is This Little Problem

But before you throw away your pills, read the but.

Continuing from the article -- First, sleep deprivation is not as convenient as taking a pill.  Actually that's debatable.  No doctor's appointment, no worries about in or out of network, no copay, no trip to the pharmacy, no need to check the formulary...  If that were the only downside, it would have much to commend it.

Second, prolonged sleep deprivation is not exactly a desirable state; it leads to cognitive defects, such as reduced working memory and impaired decision making.  Translation: NOT relatively safe.  I remember when my son was three months old and I had just gone back to work.  I stopped at the stop sign, looked both ways, and then pulled out in front of oncoming traffic.

Finally, depression recurs after the mother, inevitably, succumbs to sleep, even for a short nap.

Oops.

Wait a minute -- this is the New York Times here.  Read that again.

Sleep deprivation is wonderful cure for depression.  It's quick, cheap and safe.  That's the good news.

The bad news?  A relapse rate of 100% after 15 minutes.

Yes, that would be a difficulty.

There are a few other difficulties with this stupid science report, as well.

Actually, Sleep Deprivation Is Linked To Postpartum Depression

Lori Ross, et al did a review of the literature on this subject.  Against Sejnowski's 75 studies are piles and piles of studies that assert quite the opposite, that sleep deprivation is a significant risk factor for postpartum depression, almost every woman who has postpartum depression is sleep-deprived, and improving mothers' sleep improves their mood.

Sleep Deprivation And Psychosis

The most serious risk of postpartum sleep deprivation would be psychosis.  Studies back over a hundred years, noting that the almost universal early symptom of puerperal [first six weeks after childbirth] cases is loss of sleep (R. Jones, Puerperal Insanity from the British Medical Journal, 1902).

One or two women out of a thousand experience psychosis after giving birth, putting them at risk for suicide and infanticide.  Depending on the study, 42-100% of women with postpartum psychosis also experience insomnia.  Now that is a robust finding.  Furthermore, there is evidence that sleep loss is the last straw that tips women into development of continued bipolar disorder.

Mood is a continuum item.  Depression would be on one end.  Lifting of depression moves in the other direction.  Then comes euphoria, then mania, then psychosis.

Sleep Deprivation And Mania

And speaking of mania, the experience of people with bipolar and college students is well supported in the literature, that sleeplessness can trigger mania.

Sleep For Prevention Of Postpartum Depression

All this stuff is so well known, the Women's Health Concerns Clinic at St. Joseph's Healthcare has developed a preventive intervention that is routinely offered to patients who present with high risk for postpartum depression. Can you imagine a five-day stay in a private room after childbirth?  These and other strategies aimed at improving the sleep of new moms decreased mood disorders and even psychiatric hospitalizations months after childbirth.

Sleep.  That is the REAL cure for postpartum depression.  Forget baby showers.  The kindest gift you can give a new mom is to take care of the kid while mom takes a nap.

Speaking of which,

Aimee -- get off the computer and go to bed!

flair from facebook

OMGThat'sWhatTheySaid: 2010 in Review

Best Of... Worst Of...  The turning of the year is time for evaluation and new direction.  So here is a long ago promised review and ***competition*** for 2010's Readers' Choice Best/Worst/Whatever OMG Award.

The OMGThat'sWhatTheySaid Award was invented when I began reading what scientists say about those of us who have a mental illness.  It expanded to include media contributions to idiocy, offensiveness and outrage exhibited in language about mental illnesses and the people who have them.  The OMG Award allows me to reframe idiocy, offensiveness and outrage into irony -- granting an award for what ought to receive lashes across the backside.

I intended this to be a monthly award.  But, whatever.  I keep going on a tear with some series and lose track. -- I think this blog is charting my major hypomanic cycles?  Many months go by awardless.  So here are not twelve, but just four contenders.  The titles are links to the entire original posts.

September 12, 2010: OMGThat'sWhatTheySaid -- Noncompliance

The doctor tells you to weigh your costs and benefits before you take a medication, because it is your body, your decision.  The prescribing sheet says the doctor already weighed them for you.  If you decide differently than the doctor, then you are noncompliant, you uncooperative mental case, you.

July 23, 2010: OMG!!!That'sWhatTheySaid -- Failed Method/Successful Attempt

If we hang ourselves, or take pills, or jump off a bridge and yet we survive, then we have failed.  If we die, then we were successful.  Feel the love.



March 13, 2010: OMGThat'sWhatTheySaid! -- They

This one is more global.  I gave it to myself, and to any of us who are closeted mental cases, who think, quite accurately as a matter of fact, that if we acknowledge our mental illness, we will lose authority to talk about it.


December 26, 2009: OMGThat'sWhatTheySaid! -- Stigma

I know, this one reaches back to the previous year.  But it is still tragically timely and I am still flummoxed by the good doctor, Paul Steinberg, who thinks that the President should not send letters of condolence to the families of soldiers who commit suicide in a war zone.  (Staff Sgt. David Senft is the most recently reported example.)  Steinberg's reasoning? -- It might take away the stigma of suicide.  And with less stigma, more soldiers with mental illnesses might kill themselves.

So those are the contenders for the 2010 OMG Award.  Vote in the comments.  Feel free to lobby your friends to pad the count.

If you are curious about earlier monthly awards, they include:

November 15, 2009: OMGThat'sWhatTheySaid! -- Language

What they call us and what they call themselves determines the relationship.  The fact that they name the relationship means they have the power, regardless of the words they choose.  Provider/consumer is the new PC relationship, supposedly being more mutual than doctor/patient.  But I disagree.  It does not level the playing field.  It makes one active and the other passive.  What if we called ourselves customers?

September 4, 2009: OMG!!! That's What They Said! Significant

In common usage people think significant difference means a big difference.  Researchers think significant difference means large enough that the difference was not by chance.  (If it was a big difference, they would call it robust.)  Pharmaceutical companies sell a lot of drugs because you don't know the difference.

July 23, 2009: OMG!!! That's What They Said! Relapse

This one was about a research study designed to find out if they could cause relapse in women whose depressive symptoms were in remission.  Again, feel the love.


June 13, 2009: OMG!!! That's What They Said!

Here is the post that inspired the OMG feature, in which I discover a textbook that describes suicide as one of the unfortunate complications of major depressive disorder.

And In Conclusion...

I am always delighted to receive suggestions for new awards.  Let's say it together:

Thanks for reading Prozac Monologues.  Here's hoping I can keep it up in 2011.  You, too.

photo of trophy by Sebcaen and used under the GNU Free Documentation License.

image of whipping girl from La Grande Amie, in  public domain

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10 Items Or Less -- Shedding And Keeping

Archetypes For The Turning Of The Year

For some people, New Years Day means the Rose Bowl.  For others, black-eyed peas.  For my mother, that was the day we were required to organize our clothes drawers.

Where did that come from?  You got me.  But it must be an archetypal response to the turning of the year.  Right now advertising is crowded with sales on organizational supplies.  If you don't know how to organize your sock drawer, surely there is one of those Dummies book to tell you how.

I just looked it up on Amazon.com.  Sure enough, here it is.

Responding, I suppose, to that archetypal imperative, I am currently recycling meeting agendas, staff reports, conference handouts and class notes, things I no longer need since I have become unemployed.

You know me.  Overboard is my middle name.  At 100.4 pounds and still shedding -- make that shredding now -- old checks with my social security number on them, I am well on the way to my goal for the week: to shed my weight in discarded paper.  I am not even counting paper clips and empty three ring binders. 

Benzos

The process is alternately liberating and anxiety-producing.  I dispose of old grudges, and then panic about what I might need after all.  I celebrate, and then I grieve.  I really did do a lot of good work.  And I left important things undone.

It is good that I refilled my prescriptions before I started this project.  Valium is my current best friend. 

Diets Are Hazardous To Your Health

I do not recommend shedding body weight as a New Year's resolution.  I say this every year, because it is one of the most common New Year's resolutions and it is wrong, wrong, wrong.  Dieting is the first step to gaining weight.  You know this.  You take this course every year and you flunk it every year.  When will you ever decide you have paid enough tuition for this lesson?

Yes, I know.  Having put the word diet in my blog, the mindless web crawlers will signal the advertising gods to place ads for weight loss programs on this page.  I do not endorse them.

I did lose weight a few years ago, which makes it thirty-five pounds easier to meet this week's goal.  I did not diet.  I repeat, I did not diet.  I changed the way I eat.  I changed my eating habits.  I still eat anything I want.  It's just the quantity and the frequency that changed.  I love my food.  I did not diet.

But this is not a dieting blog, and you can go searching for a better way to eat somewhere else.

This post is about shedding. 

Ten Items Or Less

My cognitive therapist is big on distraction.  So I watch a lot of movies.  A lot.  Many are movies that did not exist until they jumped off the library shelf at me.  A recent example was 10 Items Or Less.  Filmed in just fifteen days, it was an exercise in shedding all by itself.  It stars Morgan Freeman and Paz Vela, with Rhea Perlman and Danny DeVito in a drive by cameo.  And I do mean drive by.  They were on the set for all of fifteen minutes, during which time they asked for and received a couple of Starbucks lattes.  Then the director told them their lines.  Then they said them.  They never got out of their car.

So at one point Morgan Freeman, playing an actor, asks Paz Vela, playing a grocery clerk, If you could keep just ten items or less in your life, what would they be?  After she names her list, he names his.  That's eleven.  You just have to push it, she says.  This is the theme of her life in the express checkout lane, people who want eleven items when the sign says ten.

Later they change the exercise, If you could get rid of ten items or less in your life, what would they be?

Dinner Party New Year's Eve

I just got home from a dinner party with dear friends and we played that game, 10 Items Or Less.  We never got to the items we would get rid of.  The ones we would keep had so many stories behind them that we had to leave before we could finish the keepers so the restaurant could turn the table.

The right ten items can make a person rich enough, not only for a dinner party, but for a lifetime.

We will get to that other list at the next dinner party.

Ten Items Or Less

So that is my gift to you for the start of the new year, those two questions.  What ten items or less would you keep?  What ten or less would you discard?

Choose well.  You may not need wishes for the new year after all.  You may find you are already rich.

Winter sunrise by Stefan Mayrhofer, in the public domain 

shelves of file folders by Alex Gorzen, licensed under the

Creative CommonsAttribution-Share Alike 2.0 Generic license.

Cashier at Register by Young in Panama,  licensed under the

Creative CommonsAttribution 2.0 Generic license.

Happy Christmas to my Readers

Feliz Navidad



ميلاد مجيد



圣诞快乐




С Рождеством Хрисовым




Vrolijk Kerstfeest



Feliz Natal




One Last Song -- Joy To The World
This one is signed, as well.

Holiday Shopping for Loonies and Normals Alike

Last year I got an earlier start with my efforts to help you purchase the perfect Chanukah/Kwanzaa/Christmas present.  Here are the links, one for your favorite loonie, the other your favorite normal.  The first is even diagnosis specific.  The most popular pick turned out to be a bluetooth phone for the one who talks back to his/her voices, but is trying to pass.

This year, regular readers know that I have been living and breathing gingerbread.  So this post, like my own shopping, comes late in the season -- Chanukah has passed us by.

Internet.  God bless the internet.

And what with last week's post on happiness fresh in my mind, this year's holiday shopping picks combine the two issues -- where to get what makes for true happiness on the internet.  No, really!

The Sources Of Happiness

Martin Seligman's Authentic Happiness identifies three major sources of happiness, pleasure, engagement and meaningfulness.  So here are suggestions to enhance all three for your favorite loonie or normal.

Let's address one issue first.  Life circumstances, beyond having the essentials, are not really that important an influence on the measure of ones happiness.  But poverty does matter.  If the one you love lives in poverty, go to Amazon.com's gift card section, where you can find gift cards for clothing stores, restaurants, general retail, entertainment and more.  Give us bread, but give us roses are lyrics of a working women's song from the early 20th century.  It's nice, when you are poor, to have the opportunity to choose which is the higher priority this week.

Pleasure

Well, yes.  Feeling good makes you feel good. 

On the other hand, have you seen that bumper sticker, The one who dies with the most toys wins?  That bumper sticker is an example of irony.  I hope it is an example of irony.  I am sure the person who came up with it meant it ironically.  It is possible that the person on whose Lexus SUV you saw the bumper sticker might have missed the point.  That would be sad.

Irony means that the bumper sticker is not true.  The one who dies with the most toys does not win.  I just wanted to make that clear.  Of the three top sources of happiness, pleasure, engagement and meaningfulness, pleasure ranks lowest on the list, happiness producing-wise.  Our mindless pursuit of it notwithstanding.

Nevertheless, perhaps the heart's desire of the person for whom you are shopping is toys.  There are all kinds of toys out there.  Almost all of them, you can find, again, at Amazon.com.  I thought they were a book store.  No, from Automotive to Watches, with books, electronics, movies and even musical instruments between.  If you know what that heart's desire is, you can probably find it there.  If you don't know what that heart's desire is -- are you noticing a theme developing here? -- gift card.

Yes, I know.  This reads like an infomercial for one particular corporate giant that is destroying local businesses across America.  But give me a break.  And give yourself a break.  Your Chanukah presents are already late.  Christmas and Kwanzaa are bearing down like a runaway train.  I don't have time to look up a bunch of choices for you.  I have my own shopping to do.  Internet.

Who am I kidding?  I can't go into stores anyway unless medicated.  Maybe you can relate.  At least I have the Rx!

Engagement

Engagement means being absorbed in the here and now, whether in family, romance, work or hobbies.  That being absorbed is the key, because the wandering mind is an unhappy mind.  Gifts that bring the family together, or send your recipient out on a date or relate to his/her interests can enhance that person's happiness.  And you can find just the gift or gift card at... what has evidently become the Shameless Commerce Division of Prozac Monologues.

Meaningfulness

Okay, all the above is filler.  Here is what I really want to sell this season.  Making a difference.  What makes for meaning is using one's personal strengths to serve some larger end (Seligman's definition.)

One kind of strength is passion.  So let's start with a question.  What is the passion of your gift recipient?

I knew an old lady once who absolutely would not deal with that word passion.  It's a wonder she reproduced.  Like Queen Victoria, she probably closed her eyes and thought about England.  Or, being American (and Episcopalian), she probably thought about The Book Of Common Prayer.

So here is an alternative for Thelma, God rest her soul, and for you if you can't relate to the word passion.  Determination.  What is the determination of your gift recipient.  What is he/she determined to support/challenge/change/make possible in the world?

Now let's go shopping for meaning.

Clean Water For Africa

Here is my passion/determination/story.  The Episcopal Diocese of Iowa has a companion relationship with the Diocese of Swaziland.  Swaziland has had a drought for a decade or so.  There are things that could be done.  But the king has about a hundred wives, and he can't play favorites, can he?  If one has a Mercedes Benz, then each have to have her own Mercedes Benz...  So who can afford to dig wells?

But then this guy in Southeast Iowa developed this technology that turns table salt into chlorine.  For $150, we could get this thing called a chlorinator that produces enough chlorine to give clean water to an entire village.

Well, heck.  I'll buy two!  (The price is now $300).


We took a lot of them over.  Now the Swazis are making them in country.  One year a mission team came back from Swaziland with the story.  An elder from one village had told them, 


Since we got the chlorinator, not one child died last year.

Not one child died last year.

I have never spent any amount of money that has ever given me and will forever give me as much happiness as those six words.

Not one child died last year.

Give your mother or your father this story and clean water for a whole village in Africa right here.  Now we are doing Haiti, too.

So that is how this year's holiday gift-giving guide is going to work, using one's personal strengths/passions/determinations to serve some larger end.

Shopping To Serve A Larger End

UNICEF

Now you can go back to those pleasures.  Do you have a friend who loves camping?  Insecticide treated mosquito nets are a bargain for $18.18, delivery included to places in Africa where one person dies of malaria every 30 seconds.

How about a friend who bakes?  High energy biscuits will feed young children in disaster sites, 1200 for a mere $49.10, again, delivery included.

You can find these and a whole assortment of Inspired Gifts for the health, water, nutrition, education and emergency needs of children around the world at unicef.org.

Heifer International

How about a gift that keeps on giving?  Heifer International provides livestock and training to improve nutrition and generate income, lifting families out of poverty.  Recipients share the offspring with others in the community, multiplying the impact of each gift.

So do you have a friend who wants a pet but is allergic?  Three rabbits, $60.  Aaahh, aren't they sweet?!  We bought bunnies for China one year.  Hunger has been wiped out in China.  Heifer International has moved on to another country.

Do you know a cowboy wannabe?  One heifer, $500.

How about a whole ark with two cows delivered to a Russian village, two sheep to Arizona, two camels to Tanzania, two oxen to Uganda, two water buffalo to Cambodia...  There are fifteen pairs in all for $5000.  For your friend who is delusional?  (Noah/end of the world/delusional -- get it?)

We are just getting started.  Knitters, a knitting basket (llama, alpaca, sheep, angora rabbit) -- $480.  Gourmet, cheeses of the world (how cool is that! heifer, goat, sheep and water buffalo) -- $990.  Homesick Iowan, pig -- $120.  Let's not neglect our vegan friends, trees -- $60.

If you are shopping for me, I have long had my eye on that water buffalo, a mere $250.



All of these are available in shares, by the way, if that fits your budget better.

Seriously.  Water buffalo. 

Habitat For Humanity

Now let's return to where this series started and my life for that last two months, Habitat for Humanity, building affordable housing by using volunteers, including those who will own - and pay for - the houses.  Whether your designated gift recipient is Martha Stewart or Frank Lloyd Wright, Habitat has its own gift catalog with everything from light switches to flooring.  One year my sister-in-law gave me a kitchen sink. 

One.org

If I haven't hit a bulls eye yet, one.org is the meaningfulness equivalent of amazon.com.  This one may appeal to the rockers in the crowd.  Cofounded by Bono, Bob Geldof, et al, one.org created a partnership of all sorts of groups working to eliminate world poverty by 2015 -- the Millenium Development Goals.

Here you will find more about one.org.  Here you will find the partners (Bread for the World, Oxfam, Bill and Melinda Gates Foundation, various churches, etc.)  Each one has its own focus, allowing you to find your perfect match.

And since this is my blog, after all, I will put a word in for Episcopal Relief and Development, ER-D.  When earthquake or hurricane strikes, ER-D listens to local people to determine how best to help.  Then they stay with it after the cameras move on.  For example, ER-D is still working on economic redevelopment in New Orleans.  And this is one church organization you can support that will NOT ask potential recipients where they go to church.

Joy That Lasts

So there you have it.  Without leaving the comfort of home, without even having to change out of your jammies, you can find the perfect gift, one that will give joy beyond the end of the year.

Not one child died last year.

clipart from Microsoft

cotton candy photo by Maggie D'Urbano,

used under the Creative Commons License (cropped)

child with unsafe water by Pierre Holtz - UNICEF, licensed under Creative Commons

child drinking well water by Scott Harrison licensed under Creative Commons
mosquito netting by Tjeerd wiersma, licensed under the Creative Commons Attribution 2.0 Generic license
photo of rabbits by Kessa Ligerro and made available under the GNU Free Documentation License 
Entrada dos animais na arca de Noé by Giovanni Benedetto Castiglioni, public domain
photo of water buffalo by Da and made available under the GNU Free Documentation License
GNU -- somehow seems appropriate, doncha think?