Category: Bias

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Biased Publication Standards Hinder Schizophrenia Research

00Addiction, Bias, Deception, Education, Ethics and Morality, Featured news, Psychopharmacology, Therapy September, 16

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The effects of schizophrenia are profound. Characterized by delusions, hallucinations, and social withdrawal, the disorder has no known cure. The introduction of antipsychotic medications in the 1950s has helped many sufferers cope. Following diagnosis, patients usually take antipsychotics for the rest of their lives.

But recently, a 20-year study by professor emeritus Martin Harrow and colleagues at the University of Illinois found evidence to support alternative treatment methods. In fact, non-medicated patients in the study reported better community functioning and fewer hospitalizations than patients who stayed on antipsychotics.

So why do medications continue to be the most commonly prescribed treatment for schizophrenia?

Antipsychotic drugs are the largest grossing category of prescription medication in the United States, with a revenue of over $16 billion in 2010. And much of the research that exists on treatment of schizophrenia is directly funded by pharmaceutical companies, making it challenging for independent researchers like Harrow and his team to get studies published. A bias exists towards silencing unfavourable research.

An analysis looking into possible publications biases surrounding antipsychotic drug trials in the U.S. found that, of the trials that did not get published, 75% were negative, meaning that the drug was no better than placebo. On the other hand, 75% of the trials that did get published found positive results for the antipsychotics being tested.

The Washington Post wrote an article in 2012 claiming that four different studies conducted on a new antipsychotic drug called Iloperidone were never published. Each of the studies pointed to the ineffectiveness of the drug, finding that it was no more effective than a sugar pill for the treatment of schizophrenia. A publication bias like this is worrisome.

Research has also shown that staying on antipsychotic drugs for long periods of time negatively impacts brain functioning and could potentially lead to a worsening of some of the initial symptoms of the illness, including social withdrawal and flat affect.

A growing body of research is focusing on cognitive therapy and community based treatments for schizophrenia, as either a replacement for or in combination with traditional pharmacological treatments. So far, outcomes have been promising.

A study by Anthony Morrison, a professor at the University of Manchester found that patients undergoing cognitive therapy showed the same reduction in psychotic symptoms as patients receiving drug treatment. Likewise, research by psychiatristLoren Mosher, an advocate for non-drug treatments for schizophrenia, showed that antipsychotic medication is often far less effective without added psychotherapy. Onestudy by Mosher showed that patients receiving alternative community based treatment had far fewer symptoms of schizophrenia than patients who received traditional treatment in a hospital setting.

When antipsychotic medication was introduced, many hoped it would represent themagic pill for an illness previously thought to be incurable. But little was known about the long-term effects, and even today, many claims of medication efficacy or lack of side effects remain questionable.

Research in schizophrenia is burgeoning and whether a safer, more effective treatment can be developed remains to be seen. Yet for such developments to be possible, it is important for the scientific and medical communities to open themselves up to the possibility of alternative treatments instead of limiting research that challenges the status quo. While antipsychotic medications offer great benefits in terms of reducing acute positive symptoms like hallucinations or delusions, they are by no means a cure.

–Essi Numminen, Contributing Writer, The Trauma and Mental Health Report

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Transgender Homeless Youth Victimized by Shelter System

00Bias, Featured news, Gender, Resilience, Sexual Orientation, Stress, Transgender, Trauma August, 16

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At the age of three, Gale started to challenge gender norms, insisting on wearing dresses and tiaras; by age four, sobbing at his mirror image wearing pants. He began calling himself “a boy and a girl,” and later chose to identify with the female gender.

In 2010, Gale was found dead on an Austin Texas sidewalk, right outside a homeless shelter, having been denied housing. Shelter staff considered Gale’s male genitalia inconsistent with a female identity. She would have to stay with the other men. Unable to accept these terms, Gale decided to spend the night on the sidewalk, but froze to death.

A heartbreaking story; across the U.S. and Canada, it is hardly unique.

Every year, new names are added to the memorial list of transsexual people who have been killed due to transphobia. Founder of the Transgender Day of Remembrance, Gwendolyn Ann Smith explains, over the last decade at least one person has died every month due to anti-transgender hatred and violence.

Research conducted by the Canadian Observatory on Homelessness shows the reality transgender individuals face: elevated levels of daily stress resulting in missed school and work, addiction, self-harm, and chronic mental illnesses, which can lead to poverty and an inability to build a healthy, successful life.

The most vulnerable of the transgender community are its youth. Many are thrown out of their homes by parents unable to accept their gender identity. Many leave to escape daily abuse.

There is a much higher prevalence of homelessness among transgender youth as compared to other minorities.

In Canada, many transgender youth from rural areas leave unsafe home environments and come to Toronto in hopes of discovering freedom and acceptance in the city, even if it means spending a few days or weeks on the streets. But they are quickly exposed to the harsh reality of discrimination in the shelter system.

Housing discrimination is a significant concern for the transgender community. Most homeless shelters are segregated by sex. Shared shelters usually separate women and men by placing them on different floors.

Placement on the male or female floor is based on shelter staff perceptions of the youth, regardless of which gender the individual identifies with. This is problematic for those whose gender identity is not congruent with their biological sex.

Forcing transgender individuals into shelter housing with those who identify as the opposite gender falls under the definition of transphobia, the consequences on physical, mental, and emotional health are severe.

Research has shown that transgender youth are three times more likely to develop major depression, conduct disorder, and posttraumatic stress disorder. Transphobia can also lead to greater risk of developing substance abuse and self-harming tendencies.

A large study called TransPULSE investigated the current health conditions of transgender people in Canada. Results showed that, in Ontario, 77% of the transgender population had seriously considered suicide, while 45% had made an attempt to end their life. Transgender homeless youth in particular were found to be at greater risk for suicide, and LGBT homeless youth committing suicide at a rate 62% higher than heterosexual homeless youth. Based on the New York City model of the two LGBTQ shelters, the Ali Forney Center and the New Alternatives Centre, Toronto will soon be welcoming its first 54-bed shelter reserved for the gender-queer population, a promising achievement but not nearly enough.

There are many social and personal issues that accompany being young and transgender. While the personal trauma suffered by these individuals will only change with shifting views, it is up to us to provide safe spaces for this at-risk population.

– Sara Benceković, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Laughing at Mental Illness?

Laughing at Mental Illness?

10Addiction, Bias, Creativity, Depression, Embarrassment, Featured news, Health, Humor, Laughter, Self-Esteem December, 15

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Whether chuckling at a New Yorker cartoon or an episode of South Park, there is nothing wrong with a bit of laughter. But certain topics are off limits.

Depression, anxiety, psychosis. Is it ever okay to laugh at mental illness?

Many mental health advocates say that mental illness is never a laughing matter. This view was reflected in public outcry after a2013 McDonald’s ad showed an apparently depressed woman with the caption, “You’re Not Alone. Millions of people love the Big Mac.” The helpline under the ad connected callers to the McDonald’s head office. The fast-food giant faced tremendous backlash and quickly pulled the ad, apologizing to those they offended.

Psychologist Howard Samuels, founder of The Hills Treatment Centre in Los Angeles, says that when we laugh at mental health issues, we lessen the seriousness of the condition and dehumanize sufferers. He cites the example of former Toronto Mayor Rob Ford, whose substance abuse made for numerous jokes, ridicule that may have delayed his decision to seek treatment.

But Janine Hobson (name changed), a stand-up comedian for Vancouver’s Stand Up For Mental Health (SMH) and Toronto’s Laughing Like Crazy (LLC) disagrees. To her, the acceptability of finding humour in mental illness depends on who is making the joke and why. Does the person have a mental illness, and is the humour playing down the condition or helping that person connect to others?

According to Janine, a sufferer of bipolar disorder, SMH and LLC help people with mental illness overcome their conditions. As part of the two programs, participants come up with a comedy routine based on their experience with mental illness and the mental health system, performing their sketches in front of live audiences.

David Granirer, the founder of SMH and Janine’s trainer, thinks that comedy gives people with mental illness a powerful voice and helps reduce stigma and discrimination around these issues.

“People with mental illness suffer from the effects of misplaced public perceptions,” states Janine. “What do people think of the mentally ill? They’re dangerous, they’ll fly off the handle and kill you.People are afraid. The other myth is that mental illness is a symptom of a weak personality. When you have mental illness there’s a lot of shame.”

Proponents say that comedy diffuses shame and fights stereotypes. Addressing mental health issues through humour improves communication and creates a meaningful and memorable dialogue about the impact of mental illness on individuals and communities. At the same time, people with severe mental illness performing stand-up comedy—a daunting prospect for most—empowers sufferers and shows that mental illness does not have to be a handicap.

Although not a substitute for treatment, laughter can be a way for people to feel better about themselves and embrace their conditions while educating others.

“It’s a way of giving power and hope back to people like myself who are going through the system and have felt so disempowered over the years, which is so important to keeping someone spirited against the obstacles they face related to their illness,” claims Janine.

Research studies on laughter appear to support these views, showing that humour is related to the development of a positive and realistic self-concept, higher self-esteem and self-worth, and more positive emotional responses to stress. Humour that is good-natured, integrating, and non-hostile is associated with higher self-esteem and competence in interpersonal settings, and more positive feelings.

Janine emphasizes that participants of the SMH and LLC programs focus on their own experiences and make light of their ownproblems (as opposed to belittling or sensationalizing mental illness).

So, can we laugh about the frightening symptoms of schizophrenia? Hard to know, the answer depends on context. At its best, humour creates partnership, hope, and open-mindedness. At its worst, it triggers ridicule and bullying.

The difference is as thin as the line separating comedy and tragedy.

– Veerpal Bambrah, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Slavery

Human Trafficking Remains Widespread Form of Slavery

00Bias, Featured news, Gender, Health, Law and Crime, Politics, Sex, Stress, Therapy, Trauma April, 15

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Despite being mostly illegal, slavery remains a global reality.  It is estimated that over 20.9 million people are currently enslaved and involuntarily trafficked within their own countries and across borders.

In an interview with Mark Lagon, Chair of International Relations and Security at Georgetown University’s foreign service program, former Ambassador, and Adjunct Senior Fellow for Human Rights at the Council on Foreign Relations, The Trauma & Mental Health Report learned about human trafficking and the traumatic experiences survivors encounter.

Q:  What is human trafficking?

A:  Human trafficking is a contemporary form of slavery – whether for sexual exploitation or forced labour.  It’s not a general form of exploitation that we sometimes see with globalization, but rather, an extreme version.

It involves appealing to someone who is desperate for a better life and looking for economic opportunities.  The work however, often onerous and violent, is very different from what was promised.  It’s important in terms of mental health and trauma to understand that while human trafficking often involves violence, especially for sexual exploitation, much of the control is psychological by the recruiter or trafficker.

Q:  Who is most vulnerable to becoming a victim of human trafficking?

A:  Those who are desperate for a new life and wooed into a situation that is exploitative are most vulnerable.  These groups are denied access to justice; they are not treated as human beings in full under the law, women or minorities – or in South Asia, those of a lower caste.  Migrants are also particularly vulnerable.  It’s not just undocumented workers around the world, but even some legal guest workers who are, through fraud, indebtedness, and having their papers seized, vulnerable to human trafficking.

Q:  How do gender stereotypes play a role in human trafficking?

A:  Females are particularly vulnerable to human trafficking.  Public attitude that “men have always bought women for sex and they always will” is based on gender stereotypes.  Society regularly tolerates women being turned into near commodities.

But women and girls are also victims of human trafficking for labour – in agriculture and domestic services.  In Kuwait, I met a woman who had been victimized as a domestic servant.  She showed me photographs of herself taken weeks earlier.  Her employers treated her any way they wanted.  In cases like these, women and migrant workers are seen as property.

Q:  What are some signs of people stuck in trafficking situations?

A:  There are some clear danger signs.  The one key sign is people who are intimidated and afraid.  Often, victims seem isolated.  Their boss, whether a pimp or supervisor, keeps them from having access to society.

Q:  What are some barriers to receiving help?

A:  Human trafficking victims often don’t identify themselves.  They are afraid that they will be treated as criminals.

Also, aspects of the trauma are not often discovered.  Someone might be rescued but the psychological hold that their trafficker has may not be fully appreciated.  They may flee the shelters and end up going back to their tormentor because of a kind of Stockholm syndrome or post-traumatic stress.  Survivors need mental health treatment, not just shelter and physical health treatment.

Q:  Much of humanitarian work is based on the notion of restoring survivors’ “human dignity,”  Can you elaborate?

A:  All human beings are of equal basic worth and there are places where people are not treated as human beings at all.  So, dignity is key.  Two things human dignity depends on are agency – someone’s ability to thrive and prosper in making choices, and social recognition – being treated like a human being.  Human trafficking is a classic example of agency and social recognition being crushed.

Q:  How can we empower survivors?

A:  Human trafficking victims are treated like slaves, but are very seldom in shackles or in chains.  Their tormentors convince them that they are unworthy or they have no ability to flee.  It is essential to restore survivors’ dignity, giving them the therapy and mental health treatment they need.

Q:  What can the general public do?

A:  They can understand that even a small amount of public funding from the government for human trafficking victims and mental health care goes a very long way to help people have their freedom.

Q:  Tell us about your upcoming co-edited book, “Human Dignity and the Future of Global Institutions”?

A:  It looks at how the proper goal for institutions like the UN and the International Criminal Court, is to fight for human dignity, and how well they serve that goal.

I’ve written a chapter on human trafficking, and the partnerships between governments, international organizations, non-profits, and businesses that attempted to combat this issue.  And I distinguish between those partnerships that are transformative in helping people reclaim their dignity and those that are doing little for this issue.

For more resources and information on fighting human trafficking, visit the Polaris Project.

– Contributing Writer: Khadija Bint-Misbah, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

Photo Credit: Bruno Casonato//Flickr

This article was originally published on Psychology Today

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Why Does Anyone Love Men Who Won’t Love Back?

10Anxiety, Attachment, Bias, Featured news, Health, Media, Relationships, Sex February, 15

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You’ve seen the character a thousand times—the mysteriously sexy male protagonist. The lone wolf.

He saunters into women’s lives, gives them a wink, and they trip over themselves to gain his affections. Little do they know, he is incapable of such basic inclinations as love, having in fact buried his emotions years ago in the corners of his cold heart. Naturally, he becomes even more desirable, and the women who were tripping over themselves before, are now desperately crawling after him. This cannot last forever, and the lone wolf must leave. And so he does, leaving a trail of broken hearts in his wake.

The plot has appeared in many Hollywood movies, from classic westerns to gangster films to the James Bond series. Even romantic comedies have jumped on the bandwagon, with jaded, rejecting players who finally meet “the one” and struggle to learn how to love.

50 Shades of Grey, the film based on the novel about a fictional BDSM relationship, just hit theaters. Anastasia, the female protagonist, is portrayed as a normal, healthy young woman, while Christian Grey is the king of lone wolves—though presumably all lone wolves are the de facto kings of their prides.

Christian Grey has all the typical trappings of the tall, dark, and mysterious stranger. He refuses any type of romantic relationship, claiming to not be a “flowers and romance kind of guy.” He forbids Anastasia from touching him or even making eye contact during sex. Though we may shake our heads and claim we would never endorse such a relationship, the book series has sold over 100 million copies worldwide.

A quick perusal of most fan-generated lists of the sexiest fictional male characters reveals our obsession with solitary, rejecting men—James Bond, Indiana Jones, George Clooney in pretty much anything, Batman, Edward Cullen (whose heart is literally dead)—and the list goes on.

We love characters who can’t love us back. Though there are slight differences, the Christian Greys and James Bonds of the world are strikingly reminiscent of the dismissive-avoidant attachment style.

Briefly: The dismissive-avoidant style is characterized by discomfort with intimacy or feelings of vulnerability. Being emotional or dependent, for such people, is equated with weakness. Hollywood has ensured that we find this type of character irresistible. It’s hard to find a movie that doesn’t frame the solitary male as desirable. By the same token, it’s rare to find a “clingy” (or anxiously-attached) character portrayed in a positive light.

Of course fiction is fiction, but pop culture permeates our norms. It’s hard to ignore the influence on our vocabulary and perceptions of self and other. Who doesn’t secretly want to be as cool as James Bond? As nonchalant as Don Draper? Or, for that matter, as flippant as the avoidant Mary Crawley of “Downton Abbey”? Nobody wants to be the clingy ex-girlfriend or the nagging mother-in-law.

So why do dismissive-avoidant types get all the screen time, portrayed as the coolest-of-the-cool while the anxiously attached are stereotyped as clingy and annoying? Is being stoic and rejecting really better than seeking too much affection?

It’s important to draw a distinction between what actual dismissive-avoidant individuals are like and Hollywood’s portrayal of them. It’s not that being dismissing-avoidance gives you physical agility, a six-figure salary, or an arsenal of quippy pick-up lines. More likely, you would have frustrating intimate relationships, a higher likelihood of mental health difficulties, and an underlying anxiety kept at bay by defensiveness. Films often portray such individuals without the negative aspects we would more clearly see in real life.

So why continue to portray dismissive-avoidance in such glowing terms?

It sells.

Imagine if, in the first James Bond film, Agent 007 had settled down with Honey Ryder in a gated community with two kids and a dog. There would hardly be a chance for a 25-film franchise. To keep milking the character, he must never be tied down. The character rarely changes. And the producers hit “reset” when they start creating the next film.

Although 50 Shades of Grey is far from the main culprit, it is symptomatic of our masochistic submission to dismissive-avoidant characters.

But I suppose there are worse ways to spend an evening out.

Guest Writer: Aviva Philipp-Muller, The Trauma and Mental Health Report

Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Letters to My Daughter

00Bias, Domestic Violence, Education, Empathy, Ethics and Morality, Featured news, Gender, Health, Politics, Resilience, Teamwork, Trauma September, 14

We have heard countless stories speaking to the injustices and brutalities faced by women in Afghanistan. In Letters to My Daughters, Fawzia Koofi, an Afghan woman writes about her personal experiences living in Afghanistan during the civil war.

A member of parliament in Afghanistan, Koofi, 35, is chairperson of the standing committee on human rights and civil society, and a candidate for the presidential elections in 2014.

Her book is a memoir, beginning from birth when her mother left her to die from exposure. The first half focuses on Koofi’s struggles with her limited access to education. She explains that she was the only girl from her family who was allowed to attend school, and only because her father was no longer present. Once the Taliban took control, she was immediately forced to quit medical school.

 In a later section of her book, Koofi describes a trip she took to northern Afghanistan with a team of foreign surveyors. There she realized that one of the biggest difficulties faced by women was access to health care services -a problem that did not exist before the war. Once the civil war began many facilities were destroyed, and most physicians were forced to migrate to neighboring regions. 

The situation was further exacerbated when the Taliban took over. Women were no longer allowed to work in health care facilities, except in a select few hospitals (functioning under deplorable conditions) designated for women only. Male doctors were prohibited from seeing female patients and female doctors were seldom allowed to work, leaving female patients without treatment.

Many women living in smaller cities and villages still do not have access to health care services, leaving them to die from illnesses as common and easily treatable as diarrhea.

Throughout the book, Koofi describes how she consistently experienced inhumane treatment by Afghan men. Systematic gender discrimination was made worse with the arrival of the Taliban and, although they have been removed from power, the prejudice still continues in most regions to this day. 

Women are still harassed if they leave the house without their shroud-like burqas and a male chaperone. Many women around the world face domestic violence. As is often the case, the abuse occurring in Afghanistan is considered a family matter, without much hope of intervention or help from authorities.

 Koofi emphasizes that the arrival of the American forces resulted in liberation of Afghan women. Critics accuse her of being a “traitor” for siding with the Americans, and some consider Koofi to have obtained personal gain by writing a book that humiliates the Taliban and elevates the status of the U.S. 

Although Letters to my Daughters describes Koofi’s personal experiences, the memoir sheds light on the troubling hardships many Afghan women face. Although change seems more likely with a new democratic government in place, it will still take years before the women of Afghanistan are able to enjoy the opportunities that Koofi and other women are fighting for.

The book provides a fascinating insight into her personal struggle, and the struggle of so many like her. Koofi’s book is a must read for anyone interested in understanding Afghan women’s traumatic experiences.

– Contributing Writer: Fareena Shabbir, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report 

Copyright Robert T. Muller

This article was originally published on Psychology Today