Category: Health

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Trauma Exposure Linked to PTSD in 911 Dispatchers

00Featured news, Health, Post-Traumatic Stress Disorder, Therapy, Trauma, Work September, 17

Source: Public Domain at flickr

In February 2016, Gail—a 911 dispatcher with Toronto Paramedic Services—found herself in tears at work. She had just received a call about Wallace Passos, a three-year-old boy from Toronto, who fell from a 17-story apartment building to his death.

At age 57, Gail has been working as an Emergency Medical Dispatcher for 15 years. Taking calls from around the city, she dispatches the closest ambulance. All dispatchers are expected to work 12-hour shifts, at times with only one colleague on duty.

This past year, Gail’s job became especially difficult for her when she was diagnosed with Post Traumatic Stress Disorder (PTSD). Gail recently spoke with the Trauma and Mental Health Report to discuss the experience that led to the diagnosis:

“I’m still haunted by the sounds of the family crying on the phone after the three-year-old fell off the building. I imagine the boy in pain, and it’s just awful.”

Gail is not the first emergency dispatcher to experience PTSD symptoms. A study conducted by researchers at Northern Illinois University described how 911 dispatchers are exposed to duty-related trauma, which is defined as an indirect exposure to someone else’s traumatic experience. Duty-related trauma puts dispatchers at risk for developing PTSD. Participants in the study reported experiencing fear, helplessness, and horror in reaction to various calls they received.

Along with the stress of being on the receiving end of difficult calls, emergency dispatchers also deal with the pressure and demand of following protocol, despite variability in situations.

Toronto Paramedic Services follows specific protocols set by The National Academy of Dispatch. The system was developed at Salt Lake City, Utah in 1988 and incorporates a set of 33 protocols for those answering 911 emergency phone calls. On a call, everyone is treated equally and is asked the same basic investigative questions. These questions are then used to give priority to life-threatening situations and provide guidance to first responders like firefighters, paramedics, and police officers on the scene.

While the protocols can be useful for guiding dispatchers through stressful situations, in other circumstances, they can cause pain and discomfort when a dispatcher can tell that a situation is hopeless. Dispatchers are not trained to deal with each unique case differently; they are expected to follow through with the routine questions regardless of circumstances.

In the case of Wallace Passos, Gail had to give instructions for CPR despite knowing that the child was already dead.

“It’s not just that the little boy died, but I feel that I traumatized the people that were trying to help him because I was required, in my position as a dispatcher, to tell them what to do to try and save him. And I knew from their description that he was dead. But we have to follow the procedure; we have to try.”

This predicament is further compounded by the blame placed on dispatchers for negative outcomes. Gail explains:

“People curse us and call us names just because we’re doing our jobs.”

Before her diagnosis, Gail often found herself crying at work without reason; she would take a call regarding a minor injury and become emotional. Her supervisor eventually gave her permission to take a leave of absence.

Over the past few months she has had disruptive sleep, nightmares, headaches, and unexplainable muscle spasms:

“I am hyper-vigilant, especially when I hear sirens. And it doesn’t have to be an ambulance; it could be a police car or fire truck. I hear the sirens and I start tensing up and looking all around me.”

Gail has been on a year-long search for proper psychological support for her PTSD. Unfortunately, there are few mental health benefits offered to dispatchers. Gail sought help from doctors, counselors, and social workers, most of whom referred her to other mental healthcare workers without providing much support.

But there is reason to be optimistic. The Ontario government passed legislation in February 2016 for better mental health support and benefits for first responders with PTSD, including 911 dispatchers.

“It made me sad that no one was stepping up and taking care of us. I want my peers to understand what it’s like to have PTSD after doing this job because I felt so alone when it happened to me. But this new legislation is huge. I think it’s very important because it’s raising awareness around this concern.”

–Afifa Mahboob, Contributing Writer

–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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Using Mindfulness with Opioid Addicted Chronic Pain Patients

00Addiction, Chronic Pain, Featured news, Health, Mindfulness, Therapy August, 17

Source: frankieleon at flickr, Creative Commons

In March 2016, legislative bodies in Maine put a bill forward to combat the state’s rising opioid addiction problem. New restrictions on opioids for chronic pain require doctors to limit prescriptions to just 15 days, and to encourage doctors to consider non-medicinal forms of treatment.

Treatment of chronic pain involves a delicate balance between managing pain relief and risk of drug addiction or abuse. Opiates have been used for centuries to treat acute and chronic pain. There is little debate over the short-term benefits of medication, but their use for chronic, non-malignant pain is controversial.

Chronic pain is a debilitating lifelong illness, affecting more than six million Canadians. The National Institute of Health defines chronic pain as lasting for at least six months, and creating both physical and mental strain on the victim’s quality of life. Patients may experience fear, depression, hopelessness, and anxiety in coping with their pain.

At the annual 2013 American Psychiatric Association meeting, pain specialists debated how to properly treat chronic pain and explored new forms of non-medicinal treatment.

Jennifer Potter from the Department of Psychiatry at the University of Texas advocates continued use of opioid prescriptions, but cautions doctors to examine potential risk factors for substance abuse.

“The vast majority of people with chronic pain do not go on to develop an opioid addiction, so it’s important for patients to understand that if this medication benefits you, it’s not necessarily a concern. We can’t let our response to the rise in prescription drug abuse to be denying access to all people in pain who can benefit from opioids.”

But a 2015 study by Kevin Vowles and colleagues from the University of New Mexico found that, on average, 25% of chronic pain patients experience opioid misuse and 10% have an opioid addiction. So, we also need non-medicinal treatment options to care for lifelong pain.

“Patients with substance abuse issues can be treated for pain in a variety of ways that don’t involve opioids,” says Sean Mackey, Chief of the Pain Management Division at Stanford University and Associate Professor of Anaesthesia and Pain Management.

One alternative way to approach chronic pain is through mindfulness, described as the process of paying active, open attention to the present moment. When a person is mindful, they observe their own thoughts and feelings from a distance, without judging them as good or bad.

Mindfulness is based on acceptance of one’s current state, and is becoming increasingly popular among patients as a way to help with pain symptoms.

Jon Kabat-Zinn, founding Executive Director of the Center for Mindfulness at the University of Massachusetts, advocates for mindfulness-based strategies to be incorporated into chronic pain treatment programs.

Kabat-Zinn created the popular Mindfulness Based Stress Reduction approach designed to treat chronically ill patients responding poorly to medication. The eight-week stress reduction program involves both mindfulness practice and yoga, and is effective in alleviating pain and in decreasing mood disturbance and stress.

A study by Natalia Morone and colleagues at the VA Pittsburgh Healthcare System showed the benefits of mindfulness in older adults with chronic low back pain by looking at diary entries of participants throughout an eight-week mindfulness treatment program. They found that treatment improved attention, sleep, pain coping, and pain reduction through meditation.

Some participants gained better awareness of their body throughout treatment:

“It felt good to realize [through mindfulness] that I can co-exist with my pain. Being mindful helped me realize that in my angry reaction to my back pain, I was neglecting my whole body. I saw my body only through my pain, which caused me to hate my body over time. I can now see myself outside of my body, and am working day by day with my meditation to become a happier person living with chronic pain.”

The authors also found that practicing mindfulness helped participants create vivid imagery to enhance their mood and decrease pain. One patient noted:

“I hear a sound in the distance and felt it was bearing my pain away, replacing it with a joyful ‘lifting’ of my spirits.”

While no miracle treatment exists, mindfulness can help improve patient quality of life.

–Lauren Goldberg, 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

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Barriers Prevent Soldiers From Seeking Psychological Help

00Featured news, Health, Post-Traumatic Stress Disorder, Psychopathy, Therapy, Trauma August, 17

After two tours of duty in Iraq, Sergeant Eric James of the United States Army returned home to Colorado where he began experiencing symptoms of Post-Traumatic Stress Disorder (PTSD).

James sought out a military psychiatrist for his declining mental health. In over 20 hours of recorded audio, therapists and officers at Fort Carson in Colorado can be heard berating James for suggesting he may be suffering from serious mental illness and ignoring his repeated requests for help. James was told that he was not emotionally crippled because he was “not in a corner rocking back and forth and drooling.”

James’ experience in seeking mental-health treatment may be indicative of a wider, systemic issue within the military. As pleas for help go unanswered, soldiers have begun to actively avoid mental health treatment, fearing consequences like forced retirement or reduced pay.

An article in the The Globe and Mail addressed one of these issues directly:

“Because Canadian Forces members do not earn a pension until they have served 10 years, this encourages some to wait until they’ve reached that milestone before asking the military for mental health counseling and other aid.”

Mental-health programs become inaccessible as soldiers are caught between a desire to seek out support and a fear of losing financial security, potentially losing their livelihood or living with declining mental health.

Worse, a 2012 Harvard Gazette report on the US Military stated that:

“Estimates of PTSD are higher when surveys are anonymous than when they are not anonymous.”

There may be consequences for soldiers who speak up about their mental health issues, and these consequences act as a barrier to seeking help.

It’s also possible that James’ case may be an example of the old “patch ’em up and send ’em back” approach to treating members of the military, whereby doctors and therapists devise a quick fix for physical and mental problems in an effort to get soldiers back into active duty.

Donald (name changed for anonymity), a current member of the Canadian Armed Forces, told the Trauma and Mental Health Report in an interview that painkillers and antidepressants are often prescribed in place of a more comprehensive approach to health concerns. These treatments address symptoms, but not the underlying causes.

Using medications to help sufferers of PTSD manage symptoms is an important aspect of treatment. But if supportive psychotherapy is provided either on its own or alongside drug therapy, the need for medications can be significantly decreased.

A study published with the American Psychiatric Association noted that:

“While treating PTSD with drug therapy has accumulated some empirical support, the Institute of Medicine rates trauma-focused cognitive behavioral therapy as the only first-level treatment for PTSD.”

And while proper treatment for PTSD is necessary, it can be expensive. An article from the LA Times reported a military estimate of treating PTSD to be $1.5 million over a soldier’s lifetime.

For James, after an internal investigation, he was ultimately sent for treatment and received a medical retirement with benefits. Many of our military personnel receive no treatment at all, leaving them to struggle with PTSD on their own.

–Andrei Nistor, 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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A Hands-On Approach to Psychotherapy?

00Empathy, Featured news, Health, Therapy, Trauma July, 17

Source: stux at Pixabay, Creative Commons

A friend of mine, Sigourney (name changed), once told me she would never see a therapist who wouldn’t hug her. Adamant that non-sexual touch in therapy helped her feel connected, she characterized a therapist who wouldn’t touch her as rejecting, cold, and untrustworthy.

The subject of non-sexual touch in therapy is controversial, and seems to vary depending on the professional training of the clinician. A study of clinical psychologists by Cheryl Stenzel and Patricia Rupert of Loyola University shows that many practitioners worry touch can be misinterpreted as erotic, or can damage a vulnerable client. There is also the risk of ethical complaints, so most psychologists refrain from touching clients under any circumstances.

In contrast, a summary of research by James Phelan of the American Psychoanalytic Association shows that, in surveys of psychotherapists and social workers, more than 80% touch their clients in non-erotic ways. This touch might include a pat on the arm or back, a side hug, or a full-on embrace.

So, when is touch appropriate in a therapy session?

Little training or discussion exists on therapeutic touch. Students of psychotherapy are often left confused, unsure of how to proceed, and afraid to broach the topic with their supervisors. The ethics code of the American Psychological Association does not prohibit non-sexual touch, while sexual contact, of course, is forbidden. In an interview with the Trauma and Mental Health Report, social worker Cara Grosset, a 20-year practitioner of trauma counselling, says that touching a client depends on the context and the person.

“I work with children and adolescents who have experienced or witnessed severe traumas. They may have discovered a parent who died from suicide or seen their parent killed. If they are sobbing uncontrollably in a session when describing this experience, it seems almost inhuman to not reach out with a comforting and appropriate touch.”

Grosset sees many of her clients in group situations, such as summer camps for grieving youth. In this type of setting, a soothing side hug or pat on the back during a difficult discussion happens publicly, leaving little room for misinterpretation. She has found that these gestures help the healing process.

Another example of successful non-sexual touch happens when Grosset facilitates therapy with children and their parents. Some of her young clients run to her at the beginning of a session to hug her as their parents stand by. An affirming response from Grosset is important for the child to feel nurtured and valued.

But Grosset understands why some therapists are reluctant. Many clients don’t want to be touched, and it’s important to know each person’s boundaries. Touch must be for the client’s sake, not the therapist’s. And when touch helps build connection with the client, it can be a beneficial adjunct to talk therapy.

At the same time, touch can be difficult to navigate in private sessions due to ambiguous professional guidelines and taboos surrounding touch in this type of setting. Grosset’s viewpoints are substantiated by other therapists in qualitative research by Carmel Harrison and colleagues at Bangor University in Wales:

“The values of touch included the ideas that touch could offer clients support, acknowledgement and containment. Despite this, all therapists emphasised the rarity and cautious use of touch in their practice. They discussed touch as being outside the remit of clinicians, and considered how limited discussion and training perpetuated this belief.”

It’s easy to find opposing points of view. Some clients feel that a touch from their therapist increases their self-esteem and enables them to move past feelings of worthlessness. For example, a response to a blog on the website ‘Jung at Heart’ read:

“Twenty years ago, my therapy sessions were, after the first six months to a year, almost always punctuated at the end by a hug. Those hugs saved my young life.”

On the same website, others state that they would feel awkward and violated by a therapist’s touch:

“As a therapy client, I really don’t want my therapist touching me. Not a hug, or a pat of the shoulder, or even a handshake.”

In a 2015 New York Times blog, psychotherapist Hilary Jacobs Hendel explains how she spontaneously hugged a client, but still feels uncomfortable about integrating touch into her practice. Instead, she uses imaginary touch, asking her clients to visualize hugs: “Even when I think a physical hug would be therapeutic, I continue to rely on fantasy.” This unique workaround ties back to concerns of actually touching clients.

The benefit of non-sexual touch in therapy is still open to interpretation. Even thoughresearch shows that human touch is important to wellbeing, individual clients and therapists differ greatly in their beliefs on the subject, and risk-management leans toward using it sparingly if at all.

–Lysianne Buie, 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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Denmark Declassifies Transgender as Mental Illness

00Bias, Featured news, Health, Identity, Sex, Sexual Orientation, Stress, Transgender June, 17

Source: Chey Rawhoof at flickr, Creative Commons

In March 2016, North Carolina passed a law that bars transgender individuals from using public restrooms that match their gender identity, and prohibits cities from passing anti-discrimination laws that protect the rights of gay and transgender people. The bill has thrust North Carolina into the centre of a national debate over equality, privacy, and religious freedom in the wake of a 2015 U.S. Supreme Court ruling to legalize same-sex marriage.

For individuals who identify as transgender, this law has caused “emotional harm, mental anguish, distress, humiliation, and indignity,” according to U.S. Attorney General Loretta Lynch. These consequences are in addition to the emotional anguish and shame that transgender people frequently experience when their identity is classified as mental illness.

The World Health Organization (WHO) categorizes transgender individuals as having a “gender identity disorder” in their “Classification of Mental and Behavioural Disorders”.

But in Denmark, the issue is being addressed very differently.

Effective January 2017, transgender will no longer be considered mental illness in the country, and the term ‘transgender’ will no longer be listed as mental illness, making Denmark the first country in the world to remove the link between mental illness and individuals who identify with a gender other than the one they were born with.

Sexual orientation has always been a contentious topic, and homosexuality and other forms of expression of same-sex orientation are often stigmatized. According to Susan Cochran, a professor of epidemiology at UCLA, this stigma is worsened when sexual orientation is pathologized.

Research by psychologist Walter Bockting of the University of Minnesota Medical School found that transgender individuals often experience sanctioned prejudice, such as job discrimination, health discrimination, verbal aggression, and barriers to substance dependency services.

In 2014, the WHO acknowledged that linking transgender people to mental illness is harmful and pledged to remove the link from their next International Statistical Classification of Diseases and Related Health Problems (ICD)—but this version isn’t slated for release until 2017.

In response, social democrat health spokesman Flemming Møller Mortensen told The Local:

“The WHO is currently working on a new system for registering diagnoses. It has been working on it for a very, very long time. Now we’ve run out of patience, and want to send out a signal saying that if the system is not changed by October, then we in Denmark will go it alone.”

Mortensen also told Danish news agency Ritzau:

“At the moment, transgender is listed as a mental illness or behavioural problem. But that is incredibly stigmatizing and in no way reflects how we see transgender people in Denmark. It should be a neutral diagnosis.”

This is not the first transgender rights legislation that Denmark has passed. It was also the front-runner in enacting a law passed in 2014 designed to allow transgender adults to change their gender status without any legal or medical interventions. In many European countries, this is still not the case, and restrictive laws requiring sterilization and divorce are still in effect.

Amnesty International, a major player in LGBTQ human rights, has praised the Danish Parliament for their decision, which comes at a time when states in the U.S., such as North Carolina, are passing more restrictive and discriminatory legislation against transgender populations.

It is likely that the North Carolina ‘bathroom law’ will spark court cases for years to come, and a number of groups, including local LGBTQ organizations and celebrities, are boycotting the state. Even within the state, the University of North Carolina is refusing to enforce the bathroom portion of the law and, in fact, holds sensitivity orientation programs regarding LGBTQ students so that non-transgender populations will see their trans peers as equal and worthy of respect.

The entire question of transgender rights promises to be a hot-button issue with underlying mental-health implications in the coming years. But for now, Denmark is taking the first step to ensure the inclusion of transgender individuals by acknowledging them as normal human beings.

–Veerpal Bambrah, 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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Slam Poetry Facilitates Sharing Stories of Mental Illness

00Anxiety, Creativity, Depression, Featured news, Health, Relationships, Self-Esteem, Social Life, Trauma May, 17

Source: MatthewtheBryan on Deviant Art

Andrea Gibson is a spoken word artist and activist who writes with intense passion about mental illness, bullying, and social tragedy.

In her award-winning poem, The Madness Vase, Gibson speaks firsthand about the shame many feel from disclosing experiences of mental illness and suicide. In an interview with the Trauma and Mental Health Report, she explained, “The trauma said don’t write this poem; no one wants to hear you cry about the grief inside your bones.”

When asked why people use spoken word to share these sensitive and personal experiences, Gibson told the Report:

“I can say things within the context of a poem that I could never speak outside of a poem. There is a way in which a poem cares for its writer. Allows no interruption. It’s a sweetness, a generous sweetness. I think of a poem almost as a good parent who might say, ‘I’m going to hold you and have your back while you say this, and you have every right to say this.’ There is a safety in it. A holding we may not have had elsewhere in life.”

Gibson also speaks to the ways in which sharing poetry can build self-esteem and promote self-love in both speakers and audience members, and views her poetry as a form of therapy to treat anxiety and depression:

“Telling your story is healing. Telling your story to a receptive audience of listeners is even more healing. Being witness to people telling their stories is healing. There is so much pain in hiding, and spoken word is the opposite of hiding.”

Gibson’s ability to connect with her audience lies in her willingness to share her adversity battling panic attacks, anxiety, and depression. Narrating her journey with mental illness contributes to the authenticity of her poetry and resonates powerfully with viewers.

“I doubt that I would have an artistic life if I had not been pushed into it by my own flailing nervous system. Art is a shelter of sorts. At the same time, I have had shows where I was almost too panicked to speak. I had to keep saying to the audience, “I am feeling so much anxiety, I can barely get through this.” But I’m guessing in the long run even that is of some comfort to many people. To witness a panic attack on stage, and to watch art happen regardless.”

In addition to her work as a spoken word activist, Gibson created STAY HERE WITH ME in 2011, an online platform to share experiences of trauma, mental illness, of wanting to die, and of the different art forms that have prevented individuals from committing suicide. Gibson started this initiative with co-founder Kelsey Gibb, a mental-health professional and tour manager.

“Kelsey and I were on tour together while I was receiving a lot of letters from people who were struggling to want to stay alive and we wanted to create an online community that had larger reach of support. We wanted to create something that helped people want to stay.”

Gibson’s work highlights the healing power of story-telling. As an art-focused space, STAY HERE WITH ME encourages the use of art and poetry to heal, connect, and remind the audience they are not alone. Hundreds of individuals have shared personal stories through her website, finding acceptance and understanding through shared experiences.

Through poetry and mental health advocacy, Gibson is determined to build a community dedicated to helping people who have suicidal feelings.

“I want to remind individuals struggling with suicide to be sweet to the part of them that is in pain. To hold that part with gentleness and not to ask that pained part to go away sooner than it needs to. Sometimes simply letting ourselves hurt is what the hurt needs to move through us.”

–Lauren Goldberg, 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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Police “Blue Wall of Silence”; Facilitates Domestic Assault

00Anger, Conformity, Domestic Violence, Featured news, Health, Relationships, Work April, 17

Source: Stefan Guido-Maria Krikl on flickr

In January 1999, Pierre Daviault, a 24-year veteran constable of the Aylmer Police Services in Quebec, was arrested on 10 criminal charges for allegedly assaulting and drugging three ex-girlfriends between 1984 and 1999. Daviault resigned from the police force a few days later, but he was only sentenced to three years’ probation, no jail time.

In their 2015 book Police Wife: The Secret Epidemic of Police Domestic Violence authors Susanna Hope (pseudonym) and Alex Roslin describe instances of police spousal abuse within the U.S. and Canada, reporting that at least 40 percent of U.S. police-officer families experience domestic violence, compared to 10 percent of families in the general population.

Some officers are speaking up. Lila C. (name changed), a Canadian corrections officer (CO), was interviewed by the Trauma and Mental Health Report to discuss the growing issue of spousal abuse in Canadian law enforcement. Lila’s former colleague, Stephanie (name changed), was a victim of abuse. Awareness of Stephanie’s predicament, and the inability to do anything about it, affected Lila’s mental health more than anything else on the job.

Lila explained:

“Steph and I bonded very quickly and we were very open with each other, which is normal when two COs work together so often. But she never actually told me about the abuse she was taking at home. I noticed bruises on her neck myself.”

Stephanie’s perpetrator was her husband—a long-time police officer of the Peel Regional Police in Ontario. He was a man Lila knew well, and considered a friend:

“At first I didn’t want to believe what I was seeing and I kept quiet for the first few hours of our shift that day. But eventually, I asked ‘what’s that on your neck, what’s going on?’ And then came the breakdown period and she told me everything.”

Upon opening up to Lila, Stephanie revealed that she was frequently abused by her husband at home, both physically and verbally.

“My first gut response was ‘you need to leave him and tell someone’. I mean, how could he continue to work in law enforcement, deal with these types of cases on the job, and then go home and abuse his wife off the job? But Steph wouldn’t do it—she wouldn’t leave him. She felt that she wouldn’t be able to have him arrested. If she called the police to report him, who would believe her?”

In Police Wife, authors Hope and Roslin argue that one factor perpetuating abuse is that many officers think they can get away with it.

Carleton professor George Rigakos explains in an interview with Hope and Roslin: “A major influence in the use of domestic violence is a lack of deterrence. If there is no sanction, then it’s obvious the offence goes on.”

Referred to as the “blue wall of silence”—an unwritten code to protect fellow officers from investigation—officers learn early on to cover for each other, to extend “professional courtesy.”

And when a woman works up the nerve to file a complaint, police and justice systems often continue to victimize her. She must take on a culture of fear and the blue wall of silence, while simultaneously facing allegations of being difficult, manipulative, and deceptive.

Lila explains:

“I mean, I saw her almost every day and it was a huge elephant in the room. We didn’t bring it up again. And though I didn’t see her husband often, when I did see him, it was weird. He had no idea that I knew—I just couldn’t be around him, knowing what he was doing. But there was no getting away from the constant reminder of this unspoken and undealt-with abuse.”

Knowing both the victim and the perpetrator, knowing that the abuse was not being addressed on a systemic level, and feeling powerless to do anything about it herself affected Lila’s mental health and enthusiasm about the work she was doing:

“About two months in, I started having panic attacks on my way to work and even during my shift. I vaguely remember nights where I had bad dreams. It’s weird, I wasn’t even the one being abused, but I felt unsafe. I knew that I couldn’t say anything, because it would probably make things worse. I feared for Steph’s life, but in some strange way, I also feared for my own.”

Many officers face ostracism, harassment, and the frightening prospect of not receiving support when they do not abide by the blue wall of silence. Believing she would not be taken seriously if she decided to come forward (because of her gender) only amplified Lila’s sense of powerlessness and anxiety.

“I know that the system is unjust towards women, and that makes this situation even more hopeless to confront.”

Stephanie eventually left the corrections facility where she and Lila worked, and they gradually lost touch. Lila doesn’t know if Stephanie is still with her husband, and looking back she partly wishes she had said something about it.

Hope and Roslin explain in Police Wife that we are often reluctant and afraid to intervene if we think a friend or family member may be in a violent or abusive relationship. They encourage bystanders to acknowledge the courage it takes to reach out.

–Veerpal Bambrah, 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

Lena Dunham's Representations of Mental Illness

00Anxiety, Asperger's Syndrome, Featured news, Health, Media, Obessive-Compulsive Disorder, OCD, Self-Esteem March, 17
Karolina Reis on Flickr

Source: Karolina Reis on Flickr

Media portrayals of mental illness are often controversial and have been criticized for inaccurate stereotypical depiction.

But more recently viewers have seen a notable shift towards more accurate representations. Writers, producers, and actors are using their own experiences to create more authentic characters and situations.

The controversial television series Girls on HBO leads the way.

Lena Dunham –actress, writer, director, and executive producer of Girls– stars as the show’s protagonist Hannah Horvath, who struggles with obsessive compulsive disorder (OCD). Through her character, Dunham conveys her own personal journey, enabling viewers to observe genuine symptoms of the illness.

Dunham was diagnosed with OCD around age 9. In an excerpt from her new book, she discusses the experience of intrusive thoughts:

“I am afraid of everything. The list of things that keep me up at night includes but is not limited to: appendicitis, typhoid, leprosy, unclean meat, foods I haven’t seen emerge from their packaging, foods my mother hasn’t tasted first so that if we die we die together, homeless people, headaches, rape, kidnapping, milk, the subway, sleep.”

As a public figure, Dunham feels a responsibility to discuss her disorder openly. She believes this approach helps people better relate to those who live with mental illness.

Researchers Joachim Kimmerle and Ulrike Cress explored this in an article published in the Journal of Community Psychology. Their study demonstrated that we can learn about mental illness from fictional shows when the information is accurately presented, highlighting how there can be many useful and creative ways to disseminate knowledge in mental health.

However, research by Nicole Mossing Caputo, a marketing and public relation specialist, and Donna Rouner, who has her PhD in mass communication, at Colorado State University found that when viewers don’t relate to the storyline or don’t form an emotional bond with a character, social stigmas tend to persist.

When a link to a storyline is successful or an emotional bond is formed, viewers become less critical and adopt the protagonists’ perspective and understand their struggle. Connections to narratives and characters like Hannah Horvath help battle misconceptions.

Another show, Parenthood, candidly explores the struggle of living with Asperger’s Syndrome (Autism Spectrum). Like Dunham, the show’s creator Jason Katims uses his own experience of raising a son with Asperger’s to connect with viewers on issues surrounding mental illness.

Dunham’s representation of OCD on television has increased public discussionaround mental health. It has increased the visibility of various mental-health communities and has helped pave the way for other shows to do the same.

In a Psychology Today article, Jeff Szymanski, Executive Director of the International OCD Foundation, speaks to this progress:

“Lena did a service not only to herself by letting the world ‘see’ what the struggle looks like, but to the entire OCD community at large by showing some of the pain, stigma, and struggle any person with mental health issues has to endure.”

And many are taking notice.

Shortly after Girls first aired, Allison Dotson—an OCD sufferer herself—wrote an articlefor the Huffington Post explaining how the depiction of Hannah on Girls has helped fight stereotypical portrayals of her disorder:

“As someone with OCD, I find it refreshing to see this often misunderstood illness portrayed in a realistic way on an acclaimed television show. Just as Hannah herself resists typical far-fetched sitcom stereotypes — she’s not model thin, she struggles with her finances and her career choices, and she often finds herself in believable awkward situations — her OCD symptoms are presented in a way that resists the low-hanging fruit of a kooky character most of us never encounter in our day-to-day routine.”

– Alyssa Carvajal, 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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Photography Documenting Mental Illness Draws Criticism

00Caregiving, Emotional Intelligence, Empathy, Featured news, Health, Relationships, Resilience March, 17

Source: ethermoon on flickr, Creative Commons

For the past six years, Melissa Spitz of St. Louis, Missouri has been using photography to illustrate her mother’s experience with mental illness, referring to it as a form of “documentary photography”.

The photographs taken of Melissa’s mother Deborah are shared on Melissa’s professional website and on her Instagram in a project she calls “You Have Nothing to Worry About.” They artfully depict Deborah’s lifelong struggle with bipolar disorder, schizophrenia, depression, dissociative identity disorder, and problem drinking.

In an interview with Time Magazine, Melissa explained that the series aims to provide an intimate look into the life of an individual suffering from mental illness. She told Dazed Digital:

“For me, mental illness has a face and a name—and that’s mum.”

Melissa first became aware of her mother’s mental-health problems when she was a child, and Deborah had to be institutionalized for “psychotic paranoia”. After years of anger and blame, Melissa picked up her camera as a way of confronting her mother’s disorder head-on.

The project became an emotional outlet for Melissa to facilitate healing. In an interview with Aint Bad Magazine, she explained:

“By turning the camera toward my mother and my relationship with her, I capture her behavior as an echo of my own emotional response. The images function like an ongoing conversation.”

Research published in the Journal of Public Health has shown that creative media can serve as powerful tools to help people express feelings of grief. Art therapy specifically can provide a means of expression, relieve emotional tension, and offer alternative perspectives.

Through her project, feelings of pain and hurt that Melissa held toward her mother were ameliorated, and she found herself feeling greater empathy, visually acknowledging her mother’s struggle with mental illness.

While the project is not without its merits, the provocative nature of the photographs—ranging from Deborah’s hospitalization to images of her unclothed and bruised—may elicit shock and discomfort in viewers.

Which raises the question: where do we draw the line between exploitation and freedom of expression in art depicting mental illness?

Laura Burke, a drama therapist from Nova Scotia, Canada, sees Melissa’s project as crossing an ethical line. Laura was diagnosed with schizophrenia in 2005, and has suffered from depression her entire life. She believes that people with mental illness are often spoken for, and this is a common trap in representing their lives through art.

In an interview with The Trauma and Mental Health Report, Laura commented on Melissa’s project:

“It appears sensitively done, but the line between exploitation and reverence is a tough one to walk. If the focus was more explicitly on Spitz’s perspectives of her mother, and not an objective account of how things happened, which is sometimes how a photo can appear, I might feel more comfortable with it.”

Another issue that can arise is the power differential between photographer and subject. Even when consent is provided, subjects who struggle with mental health issues are particularly vulnerable when someone else is formulating the vision and acting as “the voice” of the art piece.

Laura addressed this concern in her interview:

“I feel that focusing more on the family member’s experience, and less on the subject living with the mental illness would be a less exploitative choice.”

Melissa is aware of the criticism her project has garnered from audiences. In an interview with Time Magazine, Melissa said:

“I am fully aware that my mother thrives on being the center of attention and that, at times, our portrait sessions encourage her erratic behavior. My hope for the project is to show that these issues can happen to anyone, from any walk of life and that there is nothing to be ashamed about.”

Despite the criticism, art can be transformative for both the artist and the audience by exposing mental illness in its rawest form. Max Houghton, a Senior Lecturer in Photojournalism and Documentary Photography at the London College of Communication, appreciates what Melissa’s project can do, and how it can help break down stigma surrounding mental illness.

Houghton told BBC News:

“I think photojournalism is criticised when it looks at the miserable side of life and depressing issues. However, in the right hands, photography can be used as a tool to discover and tell important stories differently”.

Projects like Melissa’s You Have Nothing to Worry About often spark much needed discussion around mental illness and are important and necessary to address stigma. And yet, one is left wondering whether such depictions of the vulnerable may do more harm than good.

–Nonna Khakpour, 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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Staffing Shortage Underserves Long Term Care Residents

10Aging, Cognition, Dementia, Featured news, Health, Loneliness, Social Life February, 17

Source: Chris Marchant on flickr, Creative Commons

In the summer of 2014, I volunteered at a long-term care facility (LTC) in the Peel Region of Southern Ontario. Most of the residents who lived there were diagnosed with some form of cognitive impairment, primarily dementia. I saw first-hand the unfortunate reality of understaffing, and how it leads to deficits in patient care.

As the elderly population has grown, Ontario has seen a 22% increase in admission rates of LTC residents as of 2014. And the number of residents with cognitive impairments is especially high. According to the Ontario Long Term Care Association’s 2014 annual report, 62% of residents have Alzheimer’s disease or another form of dementia resulting from stroke, developmental disability, or traumatic brain injury.

Patients with cognitive impairments may have other mental health disorders as well. The Canadian Institute for Health Information (CIHI) indicates that 25.9% of residents in Ontario long-term care homes have shown symptoms of depression through 2013 and 2014.

In my time volunteering at the LTC, I noticed that residents often refrained from socializing because they were unable to take part in events due to memory deterioration, speech issues, and physical ailments such as paralysis or arthritis. Most residents required staff to transport them from one place to another and though they worked hard to support residents, there were simply not enough staff to supervise these daily activities.

Jane (name changed for anonymity), the Supervisor of Activation at an LTC in the Peel Region, spoke to the Trauma and Mental Health Report about this issue. Jane is responsible for organizing activities that motivate elderly residents to engage in social interaction and improve cognitive well-being.

Jane agreed that one of the biggest challenges for LTCs is staffing:

“Year by year, the case load of different residents is increasing, but with such little funding we do not have enough staff to support their needs. If residents aren’t participating in daily events and activities, their cognitive functioning is negatively impacted.”

A University of Ottawa study found that between the years 2000 and 2010, over 60% of residents with multiple cognitive deficits lacked stimulating therapeutic activities and social support. It showed that while residents received sufficient assistance with physical needs, such as feeding and changing, cognitive functioning continued to worsen in areas like memory and attention.

Jane also explained that despite research emphasizing the importance of activities that are engaging, staffing shortages make it difficult for these activities to be held in LTC homes:

“We need more activation staff for art therapy, music therapy and physiotherapy as these activities are beneficial to residents’ cognitive functioning. However, many activities are cancelled or postponed because of a lack of staff to facilitate the activities and monitor the residents. A few years ago, residents only needed one staff member or nurse for assistance, now they need two or more people. Sometimes, they’re left waiting for support.”

But perhaps the real issue here is funding. Adequate funds are necessary to increase the amount of staff within LTCs, so that residents can develop social relationships, participate in interactive activities, and improve their cognitive functioning and capabilities. Jane agrees:

“Funding hasn’t increased yet the resident conditions are changing and they require more care. The caseload is increasing, with little funding.”

Funding should also be allotted for appropriate staff training. LTC residents with cognitive impairments have a unique set of needs. According to the University of Ottawa study, residents require assistance in areas such as memory retention and engaging in regular social activities to help them interact and feel like recognized members of their community.

Making use of mental health first aid programs, such as the workshops offered atConestoga College and the Baycrest Health Sciences’ Geriatric Mental Health Serviceconference, can go a long way in improving the services staff provide.

As a past volunteer for an LTC home, I have seen the impact of limited support on residents’ lives. Greater funding and more staff to facilitate therapeutic activities are crucial to optimizing the care residents receive and to ensuring better cognitive functioning.

–Afifa Mahboob, 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