The New York Times - 08.10.2019

D4 N THE NEW YORK TIMES, TUESDAY, OCTOBER 8, 2019

Women who have a

hysterectomy may be

at increased risk for

depression and anxi-

ety, a new study reports.

Researchers used medical
records of 2,094 women who had

had a hysterectomy without
removal of the ovaries, matching

them with the same number of
women of the same age who had

not had the operation. None of
the surgeries were performed to

treat cancer. They followed them
for an average of 22 years.

Over all, a hysterectomy was
associated with a 26 percent

increased relative risk for de-
pression and a 22 percent in-

creased risk for anxiety. Women
under 35 who had a hysterecto-

my were at a 47 percent in-
creased risk for depression and a

45 percent increased risk for

anxiety. The reason for the oper-

ation — fibroids, menstrual

disorders or uterine prolapse —

did not affect the association.

The observational study, in the

journal Menopause, controlled

for dementia, substance use

disorders, hypertension, coro-

nary artery disease, arthritis, all

types of cancer and more than a

dozen other mental and physical

conditions.

“Hysterectomy is right for

some women,” said the lead

author, Dr. Shannon K. Laughlin-

Tommaso, associate professor of

obstetrics and gynecology at the

Mayo Clinic. “But there is this 4

to 6 percent of women who will

be affected by depression or

anxiety. We’re hoping women

will talk with their doctors and

see if there’s any alternative they

could use instead.”

WOMEN

Depression After Hysterectomy

Having an optimistic
mind-set may reduce
the risk for cardiovas-
cular disease and
early death, a review of studies

has found.
In previous studies, optimism
has been shown to be associated

with a range of favorable physi-
cal health outcomes and with
greater success in work, school

and relationships.
This new meta-analysis, pub-
lished in JAMA Network Open,

included 15 studies that meas-
ured optimism and pessimism by
asking the level of agreement

with such statements as “In
uncertain times, I usually expect
the best,” or “I rarely expect

good things to happen to me.”
Analysis of the 10 studies that
looked at heart disease, which

pooled data on 209,436 people,
found that compared with pes-
simists, people with the most

optimistic outlook had a 35 per-

cent lower risk for cardiovascu-

lar events.

Nine studies with data on

all-cause mortality included

188,599 participants and found

that optimists had a 14 percent

lower risk of premature death

than the most pessimistic people.

The studies had an average

14-year follow-up and controlled

for various health and behavioral

characteristics, including a wide

range of cardiovascular disease

risk factors.

“It seems optimists have

better health behaviors,” said the

lead author, Dr. Alan Rozanski, a

professor of medicine at the

Icahn School of Medicine at

Mount Sinai. “They’re more

likely to exercise and to have

better diet. And there is evidence

of direct biological effects — they

have less inflammation and

fewer metabolic abnormalities.”

MIND

An Upside to Positive Thinking

In Brief NICHOLAS BAKALAR

We l l

PHYSICALLY FIT YOUNG ADULTS have

healthier white matter in their brains and

better thinking skills than young people

who are out of shape, according to a large-

scale new study of the links between aero-

bic fitness and brain health. The findings

suggest that even when people are youthful

and presumably at the peak of their mental

prowess, fitness — or the lack of it — may

influence how well their brains and minds

work.

We already have plenty of tantalizing evi-

dence that aerobic fitness can beneficently

shape our brains and cognition. In animal

experiments, mice and rats that run on

wheels or treadmills produce far more new

neurons in their brains than sedentary ani-

mals and perform better on tests of rodent

intelligence and memory. Similarly, studies

involving people show strong relationships

between being physically active or fit and

having greater brain volume and stronger

thinking abilities than people with low fit-

ness or who rarely exercise.

But most of these past studies focused on

middle-aged or older adults, whose brains

often are starting to sputter and contract

with age. For them, fitness and exercise are

believed to help slow any decline, keeping

brain tissue and function relatively youth-

ful. Much less has been known about

whether fitness likewise might be related to

the structure and function of healthy,

younger people’s brains.

So, for the new study, which was pub-

lished last month in Scientific Reports, sci-

entists at the University of Münster in Ger-

many decided to look inside the skulls of a

large group of young adults.

They began by turning to a hefty trove of

data gathered as part of the Human Con-

nectome Project, an international collabo-

rative effort that aims to help map much of

the human brain and tease out how it works.

As part of that project, more than 1,200

young men and women in the United States

recently agreed to have their brains

scanned with a specialized type of M.R.I.

that looks at the health of their brains’ white

matter. White matter consists of the many

connections between neurons and brain re-

gions. It is, essentially, the brain’s communi-

cations wiring. (The working neurons make

up the brain’s gray matter.)

The volunteers, who mostly were in their

20s, also completed multiple questionnaires

about their health and lives, a general medi-

cal checkup, and a two-minute walk test, a

widely used measurement of aerobic fitness

that involves walking as rapidly as possible

for two minutes, to see how far you get.

Finally, they sat through a battery of cog-

nitive tests, designed to quantify how well

they could reason and remember in various

ways.

The German researchers then gathered

all of this information and began cross-

checking it, comparing the young people’s

fitness and thinking skills, their fitness and

white matter health, and their white matter

health and ability to think.

And they found a variety of interesting

correlations. The young people, all of whom

were healthy, had covered a wide range of

distances in their two-minute walks. Some

of those young men and women covered far

less distance than others, marking them as

the least physically fit.

These relatively out-of-shape young peo-

ple generally performed worst on the tests

of memory and thinking skills, the scien-

tists found. Their brain scans also indicated

that their white matter was slightly weaker

and more frayed than in the brains of the

young men and women who had walked far-

thest in those two minutes.

These relationships remained intact

when the researchers controlled for the

young people’s body mass indexes, socio-

economic status, age, gender, blood sugar

levels and blood pressures.

In essence, the fitter people in this group

were, the more robust their white matter

looked, and the better they performed on

tests of memory and thinking skills.

The researchers were taken aback by the

strength of the associations between the

young adults’ fitness, thinking and white-

matter health, said Dr. Jonathan Repple, a

psychiatrist and neuroscience researcher

at the University of Münster who oversaw

the new study.

“There already are a few studies pub-

lished looking at older people” and their

brains and fitness, he said, “but to observe

this in a young sample was quite surpris-

ing.”

This study provides only a snapshot of

one moment in the lives of these young peo-

ple, though, and can show only links be-

tween their fitness, white matter and think-

ing skills. It cannot prove that greater fit-

ness directly caused their brains to look and

function better.

It also did not measure or ask about exer-

cise habits, so it is not clear how much or

what kinds of exercise might be needed if

you are young and want to raise your fitness

and potentially also bulk up your white mat-

ter and cognitive skills.

Dr. Repple said he and his colleagues

were planning experiments to test whether

and how various exercise programs affect

fitness and the brain in people of different

ages.

But already, this study and others sug-

gest that being fit may matter for brain

health earlier than many of us might think.

“Even at a young age, physical fitness has

beneficial effects not just on the body,” Dr.

Repple said, “but also on brain health and

brain functioning.”

PHYS ED GRETCHEN REYNOLDS

Fitness Pays Off at Any Age

Cognitive skills are linked with

being in shape for young

adults, not just the aging.

JEENAH MOON FOR THE NEW YORK TIMES

My brother Roland’s Facebook post set off a
flurry of concern throughout his social net-
work.
He’d been assaulted, he wrote, by “old-
world mentality Agent Smiths who are
threatening our ability to bring natural
plant-based Medicine and intelligent health
care to the world.” In caps, he told his follow-
ers to ALERT THE PRESS AND BRING
SIGNS OF PROTEST.
The yogis sent positive vibes; the rebels
cried fight the man; the good Samaritans
offered to jump in their cars and rescue him.
Except that Roland hadn’t exactly been
assaulted. He’d been placed under an invol-
untary psychiatric hold and forcibly sub-
dued in an emergency room at the same in-
stitution where he was training to become a
psychiatrist.
And, with that, four years ago, Facebook
snitched our big family secret: Roland, the
literary prodigy, the tenderhearted musi-
cian, the Ivy League grad, was bipolar.
Roland, who read and approved this es-
say, is the effortlessly brilliant middle child
who takes up a disproportionate amount of
space in a room, with a booming voice and
the charisma of a megachurch pastor. After
college, he moved to Hollywood and landed,
with zero experience or connections, a cov-
eted job with an A-list director. Then, he de-
cided to become a doctor, enrolling in an
M.D./M.B.A. program.
Everything about my brother is superla-
tive, including his demons: crippling insom-
nia, alcoholism and a chemical imbalance
that has repeatedly imploded his life.
I, the firstborn, am diplomatic and obedi-
ent, less concerned with standing out than
blending in. Just 17 months apart, Roland
and I constantly butted heads trying to as-
sert our individuality growing up. In sev-
enth grade, I wrote “An Older Sister’s Guide
to Having Younger Brothers,” which began:
“A smart idea, which would prevent use of
this guide, would be to just nothave young-
er brothers.” Yet, when we weren’t vying for
sibling dominance, we were always looking
out for each other.
Roland’s bipolar disorder came of age
during the same era as social media. His
episodes were unpredictable in every way
except for how predictably they manifested
on Facebook: Between 11 p.m. and 5 a.m.,
he’d push out dozens of posts per hour,
mostly psychedelic graphics and YouTube

conspiracy videos. In his selfies, he wore

cowboy boots, neon shorts and turquoise

jewelry, the spirit animal version of himself.

His Facebook timeline became his manic

stream of consciousness, and my personal

barometer for Roland’s illness.

Sometimes his posts were nonsensical

and rambling. Other times, they were lucid

but just as worrisome: “Planning my maid-

en voyage!” he captioned a photo of a sail-

boat he’d spontaneously purchased with

what was supposed to be tuition money. In-

creasingly they were vicious. Once, from his

UV-lit apartment, Roland went on Face-

book Live, strumming Springsteen on his

guitar, broadcasting untruthful claims that

he’d been abused.

Back in the early days of his illness, be-

fore there was a diagnosis, I panicked with

the appearance of every post. Would his

friends desert him? Would everyone think

our family was crazy?

Inevitably, people did ask questions. Des-

perate to protect Roland, my family agreed

to keep answers vague: “stress,” “taking

time off,” “family emergency.” We avoided

labels, squirmed through euphemisms, fo-

cused on the fixable and walked on

eggshells in his presence. I wanted to help

Roland, but I also wanted everything to go

back to normal. I didn’t know that this

would become our new normal for over a

decade.

Most people who have bipolar disorder

might have episodes that last days, or

weeks. Roland had episodes that lasted six

months. There were hundreds of miles be-

tween us, but, during these bouts, I felt as if

we were in the back seat of our 1989 Honda

Accord, throwing elbows at each other

again. I’d reprimand him for going off his

medications; he’d label me weak-minded.

He’d call me 10 times in a row at work to de-

mand money; I’d refuse. He’d threaten to

cut off contact with our family; I’d use Face-

book location services to track him and tat-

tle to my parents. We’d hang up on each

other, then five minutes later we’d do it all

over again.

One day, Roland called me in a frenzy:

“Facebook changed the algorithm! I used to

get dozens of comments and likes on my

posts. Now I get nothing!”

In fact, Facebook had started allowing us-

ers to control the content they see, and

many people wanted to see less of Roland.

Facebook is a mirror of society, after all: We

showcase birthdays and babies, not unruly

displays of mental illness.

But I never muted Roland. I came to need

those posts, to dread the silence that fol-

lowed them far more than I dreaded the ma-

nia. When he was posting, I knew he was

still alive.

During his depressions, Roland would fall

silent for weeks at a time, unable to get out

of bed, caught in a dizzying suicide spiral.

I’d hop on a flight to help my heroic parents

and brother Ryan clean up the manic

wreckage: vintage clothes piled high, busi-

ness ventures gone wrong, strangers inhab-

iting Roland’s home. Every time my phone

rang, I’d prepare to receive the news that

Roland had killed himself.

The night my brother wrote that post

from the hospital, I received a message

from a friend who had been watching Ro-

land’s Facebook activity. He was worried.

For years I’d been following a tidy rou-

tine: offer a vague nonexplanation, provide

light assurance that the situation was under

control, congratulate the friend on his new

puppy. But that night I realized how trans-

parent these weak cover-ups were. My fam-

ily’s messy reality was out in the open, on a

global platform. I couldn’t protect Roland

from the public eye any more than I could

protect him from his own mind.

I decided, this time, to tell the truth, in all

of its complex simplicity: Roland is bipolar.

Millions of Americans have bipolar dis-

order, but until Roland was found to have it,

I thought I didn’t know any. Social media

cracked open a dialogue: As I shared Ro-

land’s secrets with others, it felt as if I were

sharing their secrets. Almost everyone, it

seemed, had firsthand experience with

mental illness: a schizophrenic cousin, a bi-

polar roommate, their own struggle with

depression. Usually, when they revealed

these things, their voices quieted to whis-

pers. I recognized those whispers. They

made me realize my family wasn’t alone.

Social media users today have become in-

creasingly worried about breaches of their

privacy, sometimes vowing to abandon the

platforms. Yet I find myself strangely grate-

ful to Facebook. It forced me out of hiding

into a more honest place.

Today Roland is in recovery, having com-

pleted his M.D./M.B.A. against inconceiv-

able odds. Sometimes it feels as if his manic

episodes are in the past; other times, it feels

as if they’re around the corner. He now lives

just a few miles away, and we meet weekly

at a cafe in Los Angeles to work on a book

together about bipolar disorder. We spend

those afternoons talking openly about the

past decade. No one notices my voice in the

clamor, but his bellowing baritone capti-

vates curious onlookers.

I used to find his voice too big, too over-

whelming. Now I want everyone to hear it.

Forced to Confront the Family Secret

A sibling’s bipolar episodes

were unpredictable, except for

how they manifested online.

LUCY JONES

By LIZ EAVEY

My family’s messy

reality was out in the

open, on a global

platform.

TIES

LIZ EAVEYand her brother Roland Eavey are
writing a memoir on bipolar disorder together.