Seasonal affective disorder is a “thing” in Phoenix during summer, when depression, aggression and stifled productivity all mushroom in the relentless Sonoran heat.

Summertime Blues

Written by Jimmy Magahern Category: Valley News Issue: June 2016
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PHM0616DD STB 01Sara Dobie Bauer remembers the exact day when she officially reached her breaking point with the Phoenix summers.

“There was definitely an ‘Oh, shit!’ moment,” she says. “Where it was like, ‘Okay, now’s the time we finally have to deal with this.’ And my husband agreed.”

An author of macabre romance novels, Bauer admits to being something of a goth holdout: At 33, she loves Halloween, black lipstick, Tim Burton films and the cloudy, rainy weather endemic to Charleston, South Carolina, where she once lived. From the outset, she had her issues with the intense heat and sunshine in Phoenix, where she had reluctantly moved after her husband’s job transfer.

“There were times when I was like, ‘I can’t stay here anymore!’” she says. “By the time we hit five years, that was enough.” Finally, one sweltering summer day, Bauer had a figurative meltdown in her living room.

“I was going through some career stuff, going through family stuff, and I was not happy with these stupid summers,” she recalls. “And I just decided to take a lot of anxiety pills and drink a lot of vodka, and kind of pass out on the floor. My husband, Jake, came home from work and found me that way, and he was like, ‘Okay, we’re getting you out of here right now. You’re getting on a plane, you’re getting out of this heat and asphalt and cactus and going back to the Midwest, where it’s lush and cool.’ And I got flown home to my parents’ house in Ohio where I stayed for a week, and kind of cooled down.”

Bauer, who says she was first diagnosed with depression when she was in eighth grade, had experienced a similar form of anxiety during the winters in Charleston, where the rainfall average is about 30 percent higher than the national norm. Suffering from a range of biological effects such as a drop in serotonin and a general disruption to the body’s internal clock that about 5 percent of adult Americans experience in response to the reduced level of sunlight in winter, Bauer was diagnosed with seasonal affective disorder, or SAD, an elevated case of what’s commonly regarded as the “winter blues.”

But Bauer says she was surprised and confused when she started experiencing those very same anxieties in warm, sunny Phoenix.

PHM0616SD STB 02“I recognized the symptoms,” she says. “I realized what was going on. I was more stressed than usual, I was short-tempered, I was restless. But it was just so weird to realize I was having seasonal affective disorder in Phoenix during the summer. I looked into it and discovered it wasn’t just me. It’s actually a fairly common thing that happens to people in really hot climates.”

On the surface, it certainly seems illogical. If a lack of sunlight exposure can be tied to depression, how could anyone feel anything but elation in Phoenix, which averages close to 300 clear or mostly sunny days each year?

“You think, ‘I live in the Valley of the Sun. How could I be deficient in things like vitamin D, which we get from sunlight and we know plays a role in our mood?’” says Chip Coffey, director of therapy services for St. Luke’s Behavioral Health Center. Coffey points to a 2008 study by the American Society for Clinical Nutrition that ran a blood test on 1,192 persons living in Phoenix and Tucson and found 22.3 percent of them were deficient in vitamin D. “[So] a lot of us are deficient – myself included.”

The explanation, of course, is that many Phoenicians avoid sunlight by choice in the summer, hunkering down indoors, drawing the black-out shades and chilling with Netflix instead of getting outside, except to drive to another air-conditioned sanctuary. As a result, we not only shortchange ourselves on the mood-elevating by-products of sunlight exposure, like vitamin D and serotonin, but we also curtail enjoyment of the outdoor activities and social interactions many of us derive happiness from throughout the rest of the year.

“Those who have winter SAD go through episodes of cabin fever, where they’re holed up in their homes because of the snow or freezing temperatures and feel they can’t go out and readily do things,” Coffey says. “The same thing happens in Phoenix – and Tucson, Yuma and other cities where we have that extreme heat. We’re just as trapped indoors by the heat as someone in a colder climate is trapped by the blizzard.”

“People may not even be consciously aware of the fact that they’re isolating themselves in that way,” adds Dr. Greg Gale, chief medical officer at Terros Behavioral Health Clinic. “They may be staying indoors as a way of managing the internal tension or anxiety they feel from being exposed to the heat. But meanwhile, they’re limiting themselves from doing the activities that they enjoy, and all these things can bring forth depression.”

Phoenicians also tend to rise earlier and stay up later through the summer, to take advantage of the slightly cooled-down temperatures between sunset and sunrise – a treat that’s rapidly diminishing, too, thanks to the urban heat island effect that re-releases daytime heat stored in the asphalt back into the night air. “So then our sleep gets disrupted,” Coffey says. “Along with our eating habits. The thought of firing up the oven, cooking over the stove or grilling when it’s 110 degrees outside is not appealing, so then we get into the unhealthy eating patterns of relying on fast food. So we’re not eating well, we’re not sleeping well, and our moods can be all over the place because of that, too.” 

Just how widespread summer SAD may be is hard to determine, particularly since most of us resign to slog through the summers without seeking help. Researchers estimate it actually only affects about 1 percent of the population nationwide. In Phoenix, some mental health professionals do report seeing a higher number of patients in the summer, but pinning the cause on any one thing can be difficult.

“Here at the center, we do see more people during the summertime who check themselves into the psych hospital,” confirms Coffey. “But a lot of those are homeless people who’ll come in with minimum symptoms simply because the heat has driven them indoors, and they can’t hang out at the mall or the library 24 hours a day. They come in just seeking physical respite from the heat.”

Gale says the Terros clinics also see a lot of patients with year-round depression whose conditions are merely exacerbated during the summer by a number of factors.

“A lot of the folks that we treat in the summer already have a major depression, and it could be that this seasonal component becomes superimposed on an existing disorder or illness,” he says. “It also can be caused by more than the climate. Some folks have the kids at home full-time during the summer, and there may be financial stressors around getting them into daycare or camp, and more time commitments, running them around. It could involve more than just a disruption of their circadian rhythms.”

PHM0616DD STB 03Nevertheless, both professionals dispute the recent assertions by a team of researchers at Auburn University at Montgomery that seasonal affective disorder, of either the winter or summer variety, may actually be a myth, rooted more in “folk psychology” than objective data. The Alabama researchers examined data from more than 34,000 participants from around the country, polled every month over the course of a year, who were asked how many days in the previous two weeks they had experienced symptoms of depression. The team then obtained data from the U.S. Naval Observatory that measured sunlight exposure time in the cities where the participants lived, matched the data with the date of the polls, and found no relationship between amount of available sunlight and prevalence of depression. “We’re all pattern seekers,” says Steven LoBello, the psychology professor who led the study. “We’re always looking for explanations. But the fact is, major depression tends to be recurrent. Reoccurrences in the same season may, in fact, be nothing more than a coincidence.”

“I understand what the research is getting at,” counters Coffey. “And yet, for those of us in the field who do therapy and counseling, when a person comes in and they’re saying ‘I’m not going outside at all, I can’t stand the heat, I’m locked up in my room, I just watch TV and eat junk food and feel like I’m going to break out in tears all the time’ – well, they’re describing depression. To them, the link between what they’re feeling and the season is very real.”

Some 30 years ago, a young ASU professor by the name of Douglas Kenrick became fed up with the short tempers of his fellow commuters on Rural Road during the summer and decided to conduct a simple experiment, measuring the relationship between heat and aggression using automobiles at a stoplight.

Enlisting the help of a female assistant, Kenrick instructed her to position her 1980 Datsun at the front of the line at a busy intersection and remain stopped for a long time after the light turned green. Kenrick then counted the seconds until the driver behind her honked his or her horn. The duo repeated this experiment for 15 consecutive Saturdays between the hours of 11 a.m. and 3 p.m. during the months of April through August.

What they found was that as the summer progressed, and the temperatures rose from 84 degrees to 108, the amount of times drivers would honk their horns increased proportionally. “Not only that, but they would use hand signals they probably weren’t taught in driver’s ed,” Kenrick quips. They also measured how long the aggravated drivers would lean on their horns when kept waiting in the increasingly hot temperatures. “It went from that polite tap in April to leaning on the horn for five or six seconds in August. And we noticed it most with the drivers whose windows were rolled down, indicating their car probably didn’t have a working air conditioner.”

Since publishing his field study “Ambient Temperature and Horn Honking” in 1986, Kenrick has moved on to other areas of evolutionary psychology (his book Sex, Murder, and the Meaning of Life landed him on The Oprah Winfrey Show back in 2011). But recently, Kenrick’s decades-old examination of heat and aggression in Phoenix has been catching the interest of climate change scientists and journalists, who have begun looking at Phoenix as the prototype for where all cities might be headed if global warming continues at its current pace. In a May 2014 article for Smithsonian magazine titled “The Reality of a Hotter World is Already Here,” former Newsweek senior editor Jerry Adler talked with Kenrick and imagined a dystopian future where increased warming equals increased aggression, where each additional degree in temperature increases the rate of violent crime. He then added:

“Science fiction is one way to get a feel for what daily life might be like in a hotter world. Another way is to go to Phoenix during a late-September heat wave...”

Kenrick, a sardonic scholar whose book jackets boast he came from “a shoddy lot of hard-drinking shanty-town Irish trouble-makers,” says he’s a bit amused by the attention his three-decade-old study has been getting.

“Social psychology has done some pretty serious studies on what happens to society when things get hot,” he says. “And people have produced some pretty solid evidence that there are increases in aggressive crime in the hotter months, particularly in the South. My paper just showed that people start honking their horn at you when they get hot.”

Still, he’s a bit concerned that climate scientists are positioning Phoenix’s extreme summer heat as the norm for other cities in the future. Because if Cleveland becomes as warm as Phoenix, the temps in Phoenix will inevitably have to rise even higher. Can we survive 130 degrees, as one University of Arizona climatologist is actually forecasting as the normal summer high by 2050?

“That’s the empirical question,” Kenrick says. “Is it possible that we adapt, and that we eventually are able to tolerate more heat? I don’t know. To me it’s amazing that the guys who cut my lawn are willing to keep coming in August. That tells me that some kind of adjustment can happen.”

Physically surviving the heatwill be one thing. Surviving the attacks of other humans may be another, as the increase in temperature makes us all literally hotheads, boiling over like animated Lewis Blacks at every minor annoyance.

Craig Anderson of Iowa State University, the researcher best known for his controversial findings on the links between video games and violence, conducted a study of 100,000 people which found that for each additional degree of warming, the rate of violent crimes, such as homicides and assaults, increased by 4.19 instances within the group. Solomon Hsiang, an associate public policy professor at University of California, Berkeley and a thought leader in the study of climate and conflict, says hotter temperatures decrease economic productivity, too, with worker output dropping about 2.4 percent for every increase in degree Celsius.

Academia’s assertions play out in the increase in road rage reports we see on the local news during the summers. Although specific research on road rage offenses is scant, a survey by the American Automobile Association (AAA) polled law enforcement in the 50 largest U.S. metropolitan areas and found the highest seasonal percentage of road rage incidents, 37.8 percent, was reported to have occurred during the summer.

Domestic disturbances are prone to rise with the temperatures, too – although crisis center heads are quick to point out that abusive behavior happens in all seasons. “We tend to see a spike in calls to our domestic abuse hotline during the hot summer months,” confirms Ed Mercurio-Sakwa, CEO of Emerge! Center Against Domestic Abuse in Tucson. “But it’s clear that domestic abuse is not caused by heat or any other external factors. Domestic abuse is defined as a pattern of coercive, controlling behavior that often builds over time.” Concurs Lorie Simms, communications coordinator for Chrysalis in Phoenix, “Sadly, domestic violence occurs every day, whether it is hot outside or not.”

Lower income neighborhoods, where the cost of electricity can prevent residents from using their air conditioning and the outdoor environment often lacks the cooling ecosystem of shade trees and green open spaces more common in wealthy neighborhoods, can become pressure cookers for unrest as the temperatures rise. “I have a student who’s looking at the relationship between temperature and aggression,” says Sharon Harlan, a former ASU anthropology professor who now teaches health sciences at Northeastern University in Boston. “And she’s found it’s more common to see rising temperatures correlate with increased violence in lower income neighborhoods that are already high crime areas.”

Law enforcement data back up the notion that summer heat triggers a spike in violent crime, including sexual assault. According to the 2013 Crime in Arizona report compiled by the Arizona Department of Public Safety, the four months with the highest total number of forcible rapes in the state were July, September, August and June, in that order – despite the fact that Arizona’s population plunges by as much as 300,000 come summer. Aggravated assault crimes similarly spiked during the summer months (see sidebar). 

David Hondula, an assistant research professor at ASU’s Center for Policy Informatics, believes Phoenix does serve as an apt model for what’s to come under global warming scenarios. “We don’t expect New York City is going to become Phoenix,” he says. “But we think the way in which the Phoenix population deals with heat might be good for other cities to look at. We see that people here change their behaviors during the summer. We run at crazy early hours, we seek routes with more shade and we’re more mindful of hydration. So there are ways many of us adapt.”

The good news is, if global warming does begin to cook the planet, at least Phoenicians will have had more practice living in a virtual oven.

“What is currently seen as extreme heat is projected to become the new normal,” Hondula says. “And here in Phoenix, we deal with extreme heat as the norm for much of the year.”

For Sara Bauer, dealing with the extreme heat of the Phoenix summers required a fair amount of medication and professional counseling.

“I was on antidepressants for a lot of our time in Phoenix, and I was in therapy a lot of the time,” she says. “And it’s kind of pathetic that so much of my therapy was based on bitching about the weather! But that was really my central issue. I didn’t like it being 90 degrees on Halloween and 70 on Christmas. That just really messed with me.”

Terros’ Dr. Gale says traditional antidepressants like Paxil, Prozac and other selective serotonin reuptake inhibitors (SSRIs) can sometimes help summer SAD sufferers. “In addition to that, there are some over-the-counter remedies like St. John’s wort or melatonin and foods high in omega 3 fatty acids like salmon, walnuts and flaxseed that can help, if the depression is mild and just presents minor disruptions in your life.”

Bauer’s summertime sadness was finally alleviated when she and her husband moved to Chardon, Ohio, this past August, more to be closer to Sara’s family than to escape the heat, which she says she had at last learned to manage. Now, ironically, she sits in front of a natural spectrum energy lamp called the Happylight every morning to avoid dipping back into winter SAD episodes.

Bauer admits there are some things she misses about the Valley, particularly the monsoons and haboobs, which she says always provided a welcome break from the unrelenting sunshine, as well as her circle of friends. 

“I’ll still come back to visit,” she insists. “Just not in the summer.”