Category: Health

Autism, Bullying, and Psychological Impacts

An Ice Bucket, an Autistic Child, and a Cruel Joke

10Autism, Bullying, Child Development, Ethics and Morality, Featured news, Health, Law and Crime February, 16

Source: Lee Morley on Flickr

A social media campaign aimed at raising awareness for one health problem becomes the cruel vehicle by which awareness is raised for another.

On August 18, 2014, a 15-year-old autistic boy in Bay Village, Ohio was encouraged by five teenage friends to participate in what he thought would be the ALS ice bucket challenge. Instead, the teenagers dropped a bucket of urine, feces, and tobacco spit on his head. When the boy’s parents found a video of the prank on his phone, they immediately took it to Fox 8 News to show how children with mental illness can be victimized.

The video went viral and was met with outrage by the general public and heralded as a disgrace to the purpose of the ALS Association’s campaign.

In an interview with Fox 8 news, the boy’s mother identifies herself as Diane to protect her son’s identity:

“The bucket challenge is supposed to be raising awareness for this disease and now they’ve turned it into a sick joke. I just can’t understand why kids would do something this cruel.”

But there is nothing that can’t be used to bring about suffering, especially when the victim is an easy target.

In a study by Benjamin Zablotsky of Johns Hopkins Bloomberg School of Public Health and his colleagues, 1221 parents of children with Autism Spectrum Disorder were asked to enroll in the Interactive Autism Network (IAN) and asked about their child’s history with bullies at school. The results showed that 63% of autistic children experienced victimization by their peers at some point in their lives and that 38% were bullied in the past month. An extreme finding when compared to the average bullying rate of 20-30% reported by students in general.

The study also revealed that autistic children in regular classroom settings with peers who do not have ASD are more likely to be bullied than children who are placed in specialized educational settings.

Catherine Cappadocia, a doctoral student, along with psychologists Jonathan Weiss and Debra Pepler in the faculty of health at York University, has studied the effects of bullying on the development of autistic children. She found that autistic children who have parents with mental health issues are three times as likely to become victims, especially at a young age.

Speech difficulties also serve to increase the risk of being bullied. For autistic children who are unable to express themselves to the offenders or to authorities, victimization can become unavoidable.

A combination of many of these factors may be what led to the victimization of Diane’s son. Yet what makes this issue more disturbing is that the five juveniles responsible claimed to be his friends.

Bay Village’s County Prosecutor, head of the office’s Juvenile Division said: “The victim and the five charged juveniles were and are friends and classmates. They regularly associate with one another and, at times, engage in distasteful and sophomoric pranks. However, this incident is clearly different. It crossed a moral and legal line, and even the five alleged perpetrators understand that and have expressed regret.”

Three of the boys involved in the prank were charged with two counts of delinquency, assault and disorderly conduct. The remaining two perpetrators were charged with a single count of disorderly conduct.

Researchers Vicki Bitsika and Christopher Sharpley have shown that a large number of children with ASD often have few or no friends and spend most of their free time at school alone. Around 40% of these children have also said that the few people they believe to be their friends tend to bully them too.

Bitsika and Sharpley also explain that this harassment can create a positive feedback loop, slowing healthy development and increasing autistic children’s difficulty displaying emotions and communicating with others.

For autistic children to grow up in a healthy environment, schools, parents, and children need to be educated not only about bullying, but about autism itself.

– Afifa Mahboob, 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

Female Inmates and Psychological Impacts

Prisons Perpetuate Trauma in Female Inmates

40Bullying, Featured news, Health, Law and Crime, Post-Traumatic Stress Disorder, Therapy, Trauma January, 16

Source: r. nial bradshaw on Flickr

In May 2012, the Equal Justice Initiative (EJI) filed a complaint with the U.S. Justice Department for maltreatment of inmates in Alabama’s Julia Tutwiler Prison for Women. EJI urged an investigation of the Alabama Department of Corrections, claiming they fail to protect inmates from sexual violence.

After an on-site inspection, federal investigators confirmed allegations that officers were frequently engaging in sexual violence against inmates.

Instances of repeated rape, sodomy, fondling, and exposure were reported.

According to its website, “The mission of the Alabama Department of Corrections is to confine, manage and provide rehabilitative programs for convicted felons in a safe, secure and humane environment.”

But the reality of the modern prison system paints a very different picture.

Allen Beck, Senior Statistical Advisor for the Bureau of Justice Statistics (BJS) reported that “of the 1.4 million adults held in prison, an estimated 57,900 said they had been sexually victimized.” Statistics of abuse in local jails are similar.

Even more startling is a report by the BJS stating that 49% of nonconsensual sexual abuse in prisons involves staff sexual misconduct or sexual harassment toward prisoners.

Among those who experience the most damaging effects of sexual abuse are female inmates with preexisting mental health disorders or past trauma. These women make up a large number of prison inmates.

Charlotte Morrison, a senior attorney with the EJI, explains that to participate in the prisons’ rehabilitative programs, women are required to go through an invasive strip-search in front of male officers each day, a distressing experience for any woman, but especially difficult for those with a history of trauma or abuse.

And mental health services in prisons are either nonexistent or inadequate in supporting prisoner needs. BJS found that only 22% of prison abuse victims receive crisis counseling or mental health treatment.

The consequences are devastating. Higher rates of posttraumatic stress disorder, anxiety, depression, and suicide are frequently reported in female inmates, as well as exacerbation of preexisting psychiatric disorders.

“The key takeaway here is the levels of impunity in detention facilities” says Jesse Lerner-Kinglake, spokesperson for Just Detention International. Prison guards are often exempt from any punishment after assaulting or sexually abusing prisoners.

According to the BJS report, only 46% of sexual assault cases between staff and prisoners were referred for prosecution. In about 15% of cases, staff members were allowed to keep their jobs.

Lerner-Kinglake goes on to say that women underreport abuse because of limited legal options, and because they fear segregation and retaliation by staff.

In 2003, the Prison Rape Elimination Act (PREA) was passed into law to analyze the incidence and effects of prison rape and to provide resources, recommendations, and funding for protection. Yet a decade later, abuse persists and statistics have barely improved.

This may soon change, however, as May 15, 2014 marked thedeadline for U.S. states and territories to submit certificates or assurances agreeing to comply with PREA standards. Those not following PREA regulations face potential reductions in grant funding.

While the U.S. government is finally enforcing prisoner safety laws, inmates still suffer from limited access to mental health services.

Many organizations recognize the limitations of the prison system and work to make these services available to prisoners. For example, Just Detention International (JDI), a health and human rights initiative, provides prisons with links to community hotlines and crisis counseling for rape victims. Public ads from such organizations are also being aimed at addressing the stigma surrounding prison rape.

While these may be positive steps to improve prisoner safety, further advocacy and legislation is necessary to protect inmates’ legal rights and to facilitate rehabilitation.

– Eleenor Abraham, 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

South Koreans Use Suicide to Preserve Honour.

South Koreans Use Suicide to Preserve Honour.

10Depression, Embarrassment, Featured news, Health, Stress, Suicide, Therapy December, 15

Source: Tanla Sevillano on Flickr

The suicide of a celebrity comes as a shock to fans. In the wake of Robin Williams’ death, there was an outpouring of grief. But suicide, like many aspects of mental health, varies across cultures. In October 2008, one of South Korea’s leading actresses and national icons, Choi Jin-Sil, hanged herself.

The importance of honour in Korean culture is evident throughout Choi’s story. She often spoke of the stigma of being a divorced, single mother in the public eye, which a national entertainment columnist likened to having a personality disorder. The divorce itself was a result of domestic abuse, yet a court cited Choi’s “failure of her contractual obligations” and inability to “maintain dignity and proper social and moral honour” in its ruling.

Choi’s death was only the beginning. It led to a wave of sympathy suicides in 2008, causing a 70% increase in suicides that October. In March 2010, Choi’s younger brother killed himself by hanging, and her ex-husband also hanged himself in January 2013.

This rash of suicides is exemplary of a common Korean belief: Psychological treatment is viewed with skepticism. An interview withKyooseob Ha, a psychiatrist with Seoul National University of Medicine, describes how Koreans are averse to seeking therapy, even for severe depression. Admitting to depression is seen as a character failure, shameful to the family. It is often concealed.

The same cultural norms dictate that preserving family reputation is paramount. Families asked about their loved ones who suffered from depression and committed suicide do not wish to speak about it. A common saying, “do not kill the person twice,” means that even if the person is gone, his or her “public face” can still be ruined.

Psychologist Hyong-soo Kim at Chosun University says this public face holds such sway that even in cases where people choose to see a therapist, Koreans will pay in cash to avoid their insurance companies finding out.

Research by psychiatrist Dae-hyun Yoon, at Seoul National University and the Korean Association for Suicide, shows that Koreans are more likely to seek the aid of a priest, psychic, or room salon (where a female bartender or hostess will listen to problems) than a professional therapist. Westernization hasn’t extended to mental health.

At the same time, Korea’s depression rates continue to rise and 80-90 percent of suicides are related to depression.

Refusal of professional treatment, along with wide public acceptance of suicide may be why South Korea was ranked by the Washington Post in 2010 as having the world’s highest suicide rate(in 2014, it ranked third-highest, following Greenland and Lithuania).

This has motivated South Korea’s government to develop intervention programs such as jump-barriers on bridges, glass doors along subway platforms, and 24-hour government-funded suicide hotlines. Though progress has been slow, some Koreans believe the traditional mindset to be flawed.

Currently, the Korean government is increasing funding for mental healthcare and suicide awareness. Online monitoring has led to the closure websites that encourage people to kill themselves. Gramoxone (a pesticide that was a common means of committing suicide) is now banned in Korea. And an expanded state pension system, as well as aid from major corporations, are giving less fortunate individuals the ability to access mental health services they could not previously afford.

Turning traditional ideals on themselves, public service messages now emphasize that the shame of a loved one committing suicide outweighs whatever circumstances led them to consider suicide in the first place. They focus on the idea that honour can be regained by living.

Local therapists know first-hand the values and lifestyles of their clients, and culturally based therapeutic approaches are key to curbing South Korea’s suicide rate. In a country where honour is tantamount to life, solutions must build on tradition, not break it.

– Olivia Jon, 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

Laughing at Mental Illness?

Laughing at Mental Illness?

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

Source: Fractured-Ray on DeviantArt

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

Is Casual Sex Really So Bad?

Is Casual Sex Really So Bad?

10Anxiety, Depression, Featured news, Health, Relationships, Self-Esteem, Sex December, 15

Source: John Perivolaris on Flickr

Smartphone apps like Tinder, Grindr, Down, Tingle and Snapchat have opened up a new chapter in the complicated world of dating and casual sex.  Dubbed “hookup culture,” smartphone users 18-30 years of age are said to be navigating a very different sexual landscape than their parents did.

Early research on the topic found that undergraduates who engaged in casual sex reported lower self-esteem than those who did not.  Yet, other studies reported no evidence of higher risk for depressive symptoms, suicidal ideation, or body dissatisfaction.

According to adjunct professor Zhana Vrangalova of New York University, the phenomenon of casual sex is layered with individual, interpersonal, emotional, and social factors.  Reasons for engaging in hookups are different.

Her recently published study demonstrates that casual sex is not harmful in and of itself, rather one’s motivations for engaging in casual sex is what affects psychological well-being.

Vrangalova draws upon self-determination theory:  Behaviours arise from autonomous or non-autonomous motivations.  When we do something for autonomous reasons, we are engaging in behaviours that reflect our values – the ‘right’ reasons.  When we do something for non-autonomous reasons, we are seeking reward and avoiding punishment – the ‘wrong’ reasons.

In the context of casual sex, Vrangalova and her team of researchers were able to show that those who hooked up for non-autonomous reasons (i.e. wanting to feel better about themselves, wanting to please someone else, hoping it would lead to a romantic relationship, and wanting favours or revenge) had lower self-esteem and higher levels of depression and anxiety.

But those who engaged in casual sex for autonomous reasons – fun and enjoyment, sexual exploration, learning about oneself – reported higher than normal levels of self-esteem and satisfaction, with lower levels of anxiety.

If hooking up for the right reasons, casual sex does not appear to have a negative impact.  Still it’s not so simple.  A number of issues need to be addressed.

Many studies examine “hookup culture” on college campuses, particularly the sex life of middle to upper class young adults.  Since college years are often a tumultuous time of self-discovery and changing opinions, longitudinal research on the long-term benefits (or drawbacks) of casual sex need to be carried out.  Few studies have explored how casual sex affects the mental health of individuals above age 30.

Outside the college domain, information on how different casual sex arrangements (one night stands vs. friends with benefits vs. non-monogamy) affect mental health is scarce, as is research exploring how casual sex behaviours vary between people of different ethnicities.  Preliminary research shows that non-white women report lower desire for casual sex.  How or why this is the case has not been examined.

There is little doubt that the sexual landscape has changed in the past few decades. Technologies, and more specifically social media, have altered the way we approach and engage in interpersonal relationships. But the idea that younger generations are ditching the traditional dating scene in favour of hooking up has not been supported by recent research.

Hang-outs, group dates, friends with benefits, no-strings-attached… For those emerging adults who are engaging in these behaviours with a psychologically healthy frame of mind, is it really so bad?

– Magdelena Belanger, 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

Officers with PTSD at Greater Risk for Police Brutality

Officers with PTSD at Greater Risk for Police Brutality

00Featured news, Health, Law and Crime, Post-Traumatic Stress Disorder, Stress, Therapy, Trauma November, 15

Source: Thomas Hawk on Flickr

After dropping off a colleague on September 14, 2013, Jonathan Ferrell began his journey home.  That night, the North Carolina highway proved more treacherous than he expected.  He veered off an embankment and, shaken but uninjured, made his way over to the first house he saw to get help.  But residents mistook his intentions and called police.

It’s unclear what transpired when three officers arrived 11 minutes later.  In moments, Ferrell lay dead with 10 bullets in his body.  Autopsy reports suggest he was on his knees when shot.

Victims of police brutality have been people of all ages, races, and walks of life – from 84-year old Kang Wong, beaten for jaywalking, to a 14-year-old boy disfigured for shoplifting, to two married university professors, one of whom had undergone open heart surgery only several days prior to being struck and dragged off in handcuffs.

Police violence does not confine itself to any one area.  Hundreds of protestors suffered physical and sexual assaults at the hands of police officers during the 2010 Canadian G20 protests.  Civilians were killed and publicly tortured by police as protestors pushed for democracy in Kiev, Ukraine.

But what puts officers at risk for engaging in police brutality?  New research from the Buffalo School of Medicine and Biomedical Science points to links between police brutality and pre-existing post-traumatic stress disorder (PTSD) in the officers themselves.

PTSD is a diagnosis traditionally used for victims of overwhelmingly stressful experiences, such as rape, combat, and natural disasters.  Many victims of police violence often experience PTSD, which manifests as severe agoraphobia and paralyzing panic attacks.  This creates a downward spiral of isolation, depression, and even suicide.  Treatments for PTSD involve facing the trauma and reconsolidating the memories in more constructive ways.

But the link between PTSD and police violence appears to be a two-way street.  Not only does police brutality have the potential to cause PTSD in victims, but according to psychiatrist, Ben Green of the University of Liverpool, violence among officers may be exacerbated by their prior experiences, their previous high incidence of PTSD, which stems from being exposed to many of the same traumas as soldiers in combat.

Yet because mental health issues continue to be a source of stigma in law enforcement, many police officers suffer in silence.

In the U.S., police officer deaths from gun violence and other causes have gone up by 42% from 2009 to 2011.  And each year, 10% of all law enforcement officials are assaulted, with a quarter of them sustaining injuries.  At the same time, public pressure on police to restrain their use of firearms against the public has reduced the number of bullets fired by officers by over 50% in the last decade.  This means that police officers are finding themselves in life-threatening situations more often, but are less able to respond, creating a state of fear and tension, factors that give rise to PTSD.

For the public, the danger of police officers developing PTSD comes from an increased startle response, suspicion, and aggressiveness.  These tendencies can make officers more likely to lash out at the public and result in the deadly overreactions that sometimes occur.

Symptoms of PTSD are often triggered by the same situations that caused the trauma.  This may be why officers who kill unarmed civilians report feeling confused and suffer from memory loss when they lose control.

While many officers cite unmanageable work stress and traumatic incidents suffered on the job when explaining misconduct, few law enforcement agencies offer comprehensive mental health care for dealing with PTSD.  Among the officers themselves, talking about trauma and mental health is oftentimes discouraged, leaving sufferers isolated or stigmatized.  At the same time, the justice system also serves to cover up the problem, imposing minimum punishments for officers and giving victims of police brutality no closure to initiate their own recoveries.

Better mental health awareness would help.  Allowing police officers to speak freely and receive treatment for their job-related stress would reduce PTSD.  Teaching fellow officers to recognize the symptoms of PTSD –including social withdrawal, personality changes, and poor decision-making – would allow them to help their partners and coworkers before problems escalate.

Giving officers access to treatment and support early on can reduce future incidents of police brutality and ensure that they get the help they need.

And understanding that police officers are often victims of violence is important for continued public trust in law enforcement.  The key is education and access to treatment.

– Nick Zabara, Contributing Writer, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

Avatar Therapy Shows Promise For Voice Hearers

Avatar Therapy Shows Promise For Voice Hearers

00Depression, Featured news, Happiness, Health, Identity, Therapy October, 15

Source: Surian Soosay/Flickr

Auditory hallucinations are difficult to treat.  People show a wide range of response to antipsychotics.  And, the medications are associated with negative side effects. Psychological treatments like cognitive behavioral therapy (CBT) may help one cope with hearing voices, but they are usually not effective in quieting them or reducing their frequency.

An alternative method for voice hearers is a new computer–based approach called Avatar Therapy, developed at the University College London (UCL) by Emeritus Professor Julian Leff and his research team.

Avatar Therapy works as a collaborative process.  With the therapist, the patient constructs a digital representation of the face and voice that best suits one of their heard voices.  The therapist speaks as if they are one of the patient’s persecutors, and this speech is synced with the movement of the avatar’s lips, allowing for the patient to confront a simulation of their auditory hallucination in real time.

Patients have the opportunity to enter into a dialogue with their voices and learn how to gradually take control of the hallucinations.  By giving invisible and often menacing entities a face, these experiences can become easier to confront.  The therapeutic process allows for a safe space where the patient may practice  standing up to their voices in preparation for when they occur.

While research into Avatar therapy’s efficacy is limited to one pilot study, the results show promise.  After engaging 17 patients (who had not responded to medications) in up to seven 30 minute sessions of the therapy, patients experienced a significant reduction in the frequency and intensity of auditory hallucinations.

Also noteworthy is the abrupt cessation of voices in three of the patients who reported having experienced auditory hallucinations for 16, 13, and 3.5 years.  A follow up with these patients confirmed this cessation had continued three months after the pilot study. Patients also experienced a decrease in depression and suicidal thinking; encouraging results, since depression is often seen in cases of schizophrenia, and 1 in 10 of those diagnosed attempt suicide.

Patients were also given an MP3 recording of the conversations with their avatar from all the therapy sessions.  They were encouraged to listen to the recordings whenever they were feeling harassed by the voices.  This may have also contributed to their continued improvement.

Despite these preliminary results, Leff and his team caution that this approach may not be for everyone.  The study began with 26 patients, 9 of which dropped out.  The researchers attribute this drop out rate to the fear instilled in the patients by their voices and the threats uttered by them.

If this treatment is to have any effect, the patient must first be able to exercise a certain degree of tolerance over the voices, and be willing to manage the distress they produce. That said, another obstacle Leff and his colleagues face is working on ways to help patients develop stress management skills, so that more individuals may benefit from this approach.

The method may even open doors for further innovations in treatments for voice hearers, approaches that venture towards listening, understanding, and confronting one’s voices rather than suppressing them.

– Pavan Brar, 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

After a Stillbirth, Interpersonal Support Facilitates Coping

After a Stillbirth, Interpersonal Support Facilitates Coping

00Caregiving, Depression, Featured news, Grief, Health, Parenting, Resilience October, 15

Source: Judit Klein on Flickr

Over 2 million babies are stillborn every year worldwide, resulting from a genetic or physical defect, an illness suffered by the mother, or problems with the umbilical cord. In more than one quarter of cases, no cause can be determined.

In a recent interview with The Trauma & Mental Health Report, Heather, a mother and mature student shared her experiences surrounding stillbirth and commented on the services provided for families.

I chose to name my baby Benjamin.  I didn’t return to work after I got the ultrasound results and eventually I resigned.  I didn’t want to face the office, or their sympathy.

Immediately after a stillbirth, parents are offered various services to help manage their grief.

I was given a private room for the induction – an artificially stimulated labour – and received options for grief counselling and the services of priests and rabbis at the hospital.  We had him cremated, and the tiny basket of ashes was buried on my grandmother’s grave.  My husband and I also received genetic counselling to try to find the cause of the loss.

Parents of stillborn children have the option to see, touch, or hold their baby.  Memories that validate their experiences as parents can be created through handprints or footprints, pictures, or keeping locks of hair.  It can be overwhelming to make these decisions while coping with the reality that your child is gone, but these options may help parents make sense of their grief.

I was 21 weeks pregnant, so I was already making plans, thinking of names, and my daughter was looking forward to having a sibling.  I also looked physically pregnant… I was ready to have a baby, and in a fleeting moment he was gone.  It was so hard to move forward after that, and it was hard to reach out for help.

Interactions with hospital staff following the death of the child may influence how parents cope.  A 2013 study by Soo Downe, an associate professor at the University of Central Lancashire, found that parents believed there was only one chance to create an environment conducive to coping.  This means that positive memories and outcomes following a stillbirth depend as much on caring attitudes and behaviors of staff as on high-quality clinical procedures.

When interactions with hospital staff did not create a supportive environment, parents became distressed, which added to their grief and affected their ability to manage their jobs, family life, and mental health.  This additional stress can ultimately impact couples’ willingness to seek help.  When these interactions were more compassionate, parents were more likely to have positive, healing memories that aided their psychosocial recovery.

It is also common for parents to develop poor coping strategies, and to adjust differently after the loss of a child. Those who do not seek out services because of shame, fear, or anger tend to suffer in silence. A study by social worker Joanne Cacciatore, Faculty Associate at Arizona State University, shows that women who attend a support group develop fewer post-traumatic stress symptoms than those who do not.

Opening up to other bereaved mothers is helpful for reducing grief and other mental health difficulties.  Partners may also find reaching out to religious or spiritual leaders, funeral homes, and support groups helpful.  Online resources like blogging can also be useful for parents looking to connect in an anonymous way.

Heather was lucky to have the support and experience of the women in her family, which played a critical role in how she managed her grief.

I was grateful that my mother came out to stay with me during the termination.  Talking with her helped.  Other family members also began opening up for the first time about their experiences with miscarriage and stillbirth.  I didn’t feel so alone.

Some organizations are working to educate marital partners on coping styles and seeking out support.  The International Stillbirth Alliance works to improve stillbirth prevention and bereavement care for those who have lost a child.  Although they do not provide individual services, they work with other organizations to connect locally and globally to improve standards of care.

Women who have had a stillbirth can benefit from bereavement services and support of their loved ones.  Those who suffer in silence will likely do so much longer than they have to.

– Danielle Tremblay, 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

Cosmetic Vaginal Surgery Ignores Women’s Mental Health

Cosmetic Vaginal Surgery Ignores Women’s Mental Health

00Body Image, Ethics and Morality, Featured news, Gender, Health, Media, Self-Esteem October, 15

Source: summerbl4ck/Flickr

“I just thought I was so different from everyone else that I wanted my vagina to be changed,” said 21-year-old, Rosie, during her interview for The Perfect Vagina, a 2008 documentary on vaginal reconstructive surgery.

Rosie received a labiaplasty to remove the skin of her labia minora (internal genitalia). While the operation is relatively simple, the risks include bleeding, infection, permanent scarring, nerve damage, and a painful three-month recovery.

David Matlock, a cosmetic surgeon and director of the Los Angeles Laser Vaginal Rejuvenation Institute pioneered the vaginal surgery market in Los Angeles. He claims he can create “the perfect vagina,” a promise that brings in about 12 million (USD) a year.

But researchers at the UCLA Center for the Study of Women believe the concept of a “perfect vagina” arises from consistent exposure to homogenous images of women’s genitalia.  Pornography, medical textbooks, and sex shops show a similar vagina that is pink, hairless, with only the labia majora (external genitalia) visible.  Even the popular women’s health and sexuality book Our Bodies Ourselves shows only one image of the vagina.  Yet, the appearance of the healthy vagina is highly variable.

Why are more women opting for vaginal reconstructive surgery?  John R. Miklos, director of Urogynecology and Reconstructive Vaginal Surgery at the Atlanta Medical Center, found that most of his patients (on average 35 years of age) pursue the labiaplasty to improve sexual function, or to reduce pain during intercourse.

Other reasons for labiaplasty include alleviating discomfort from clothing or exercise, pressure from male or female sexual partners, reducing shame from having large labia minora, and boosting self-esteem.  And many labiaplasty patients are dissatisfied with the appearance of their genitalia and have lower sexual satisfaction.

Cosmetic surgeons state that women have the right to make decisions about their bodies. The American Academy of Facial Plastic and Reconstructive Surgery reported that women are the highest consumers of cosmetic surgery. In 2013, they accounted for 80% of all surgical (rhinoplasty, chin implants) and non-surgical procedures (BOTOX).

But many researchers take issue with that idea, arguing that vaginal cosmetic surgery patients often struggle with mental health.

Labiaplasty becomes problematic when young girls and women are looking for a self-esteem boost, as the surgery does not necessarily result in a positive outcome.  And for women struggling with low self-esteem, when one body part gets “fixed,” the dissatisfaction may shift rapidly to another.  This ongoing pursuit may be reflected in depression, anxiety, and even plastic surgery addiction.

However, Bruce Allan, an obstetrician-gynecologist from Calgary, Alberta, considers his patients to be very “well-adjusted people,” stating that a woman getting a labiaplasty is the same as a bald man getting a hair transplant.

Scientists at the Centre for Appearance Research at the University of the West of England have developed a psychological screening tool for all cosmetic surgery patients.  And specifically for labiaplasty candidates, there is the genital appearance satisfaction scale.

According to The American Society for Aesthetic Plastic Surgeons, psychological evaluations are not a mandatory procedure. Yet, most cosmetic surgeons are aware of body dysmorphic disorder, a chronic psychological illness characterized by obsessive, negative thoughts about one’s body and real or imagined flaws in physical appearance.  If patients opting for this surgery are doing so because they are suffering from a mental illness, one may ask whether it is indeed ethical to proceed?

Cosmetic surgeons would do well to consider the patient’s age when it comes to vaginal reconstructive surgery.  Young girls may prioritize a “quick fix” without understanding the surgery’s invasiveness.

And with adequate training to administer psychological screening tools, cosmetic surgeons could identify which patients should speak to a mental health professional before signing up for a labiaplasty.

Perhaps labiaplasty candidates can be given the opportunity to consider taking another route to address underlying body image dissatisfaction.  Patients might be better off if their doctors started tackling the problem from the top-down.

– Shira Yufe, 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

Rehabilitation Benefits Young Offenders

Rehabilitation Benefits Young Offenders

00Anger, Depression, Featured news, Health, Law and Crime, Punishment, Trauma September, 15

Source: Kim Silerio/Flickr

“We are seeing far too many young offenders entering the adult system who should be dealt with in the juvenile system,” says public defender, Gordon Weekes, in a short documentary published in April 2014, by Human Rights Watch.

With little support and a lack of rehabilitation resources available in adult facilities, young offenders prosecuted as adults are often faced with harsh protective and disciplinary measures like solitary confinement.

But, solitary confinement is just as common in juvenile correctional facilities. In 2013, an Ohio juvenile correctional facility placed a young boy in solitary confinement where he spent 1,964 hours in isolation. Referred to as K.R. in court documents, his longest period of seclusion was 19 consecutive days.

Although declining, in the 1980s through the mid-1990s, serious and violent juvenile crimes were on the rise, raising concerns about whether to subject young offenders to longer prison sentences and the same legal proceedings as adults. In 2011, Human Rights Watch (HRW) and the American Civil Liberties Union estimated that more than 95,000 youth were held in prisons, most of these facilities using solitary confinement.

A 2012 HRW report states that solitary confinement is often used to punish young people for misbehavior, to isolate children if dangerous, to separate children vulnerable to abuse from others, and for medical reasons (including suicidal ideation).

Yet, research shows that solitary confinement can cause serious psychological and developmental harm to children, and can have a detrimental effect on one’s ability to rehabilitate.

In the HRW report, adolescents indicated a range of mental health difficulties during their time in solitary confinement. Thoughts of suicide and self-harm were common. Several participants even described that their requests for mental health care were not taken seriously.

Kyle B., a participant of the HRW study recalled:

“The loneliness made me depressed and the depression caused me to be angry, leading to a desire to displace the agony by hurting others. I felt an inner pain not of this world… I allowed the pain that was inflicted upon [me] from my isolation placement to build up. And at the first opportunity of release (whether I was being released from isolation or receiving a cell-mate) I erupted like a volcano.”

According to researchers at the 2014 Advancing Science Serving Society annual meeting, prisoners kept in isolation lose touch with reality, and can develop identity disorders after spending long hours without social interaction. It can also be damaging to individuals with pre-existing mental illnesses or past childhood trauma.

Incarcerated adolescents who have been accused or found guilty of crimes can be extremely difficult to work with.  UN Special Rapporteur on torture, Juan E. Méndez, advises that “solitary confinement should be used only in very exceptional circumstances, for as short a time as possible.”

The US Supreme Court has consistently emphasized the importance of treating young people in the criminal justice system with special constitutional protections regarding punishment. Since solitary confinement is physically and mentally harmful to adolescents, many are calling for reform.

The HRW report suggests alternatives to solitary confinement to foster rehabilitation. They suggest increasing the number of trained supervised staff in facilities, like social workers and other mental health professionals. Providing adolescents with programs and activities in groups may help with development and rehabilitation. The HRW also emphasizes rewarding positive behaviours instead of punishing bad ones.

Research has also linked the role of education to improved behaviour and lower rates of delinquency among incarcerated youth.

Along with appropriate mental health care, education may improve rehabilitation efforts and assist youth in productive re-entry into their communities.

– Khadija Bint Misbah, 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