Category: Health

The Changing Face of the Heroin Addict

The Changing Face of the Heroin Addict

00Addiction, Featured news, Health, Law and Crime May, 15

Source: Jonathan Silverberg / Flickr

Hollywood and much of the Western world was shocked by the sudden passing of actor Philip Seymour Hoffman in February of 2014.  Reports rapidly circulated that Hoffman, 46, was found dead from an overdose, with a needle in his arm and multiple bags of heroin nearby.  Described by the New York Times as “one of the most ambitious and widely admired stars of his generation,” Hoffman did not fit the stereotypical profile of a heroin user.

His death has brought an alarming pattern to light.  New heroin users are not necessarily troubled or poverty stricken persons from inner city environments.  Many are younger, “middle class,” and from rural or suburban areas.

Governor of Vermont, Peter Shumlin, gave an unprecedented “State of the State” address that focused exclusively on the massive surge of heroin abuse in his state.  Calling it a “full-blown heroin crisis,” Shumlin explained that heroin use in Vermont has increased over 770% in the past decade, with 4300 new addicts in 2012 alone.

Vermont is a small state known for its idyllic cottage country and rural areas.  Unlike neighbouring states New York and Massachusetts, it lacks the large urban sprawl usually associated with drug addiction.  Its unemployment rate is the seventh lowest in the country, and nearly everyone has some form of health insurance.

Fifteen years ago, Vermont saw a massive jump in the amount of OxyContin addictions across the state.  OxyContin is a powerful and highly addictive narcotic painkiller.  Its opiate effects quickly build a tolerance and produce a powerful, euphoria-inducing high.

Many of those who became addicted were middle and working class individuals who sought pain relief for a variety of injuries –some legitimate, others not.  Many now claim that doctors were over-prescribing and setting patients up for destructive drug addictions.

In 2010, North American pharmaceutical companies, in reaction to a strong push from anti-drug groups and legislators, replaced OxyContin with a new version that was supposed todeter drug abuse.  The newer drug, OxyNeo, is much harder to break up and becomes a gel-like substance in water, making it difficult for users to crush and snort or “cook” and inject.

Around the same time, new legislation was drafted to make access to OxyContin more difficult to obtain.  In Canada, the Narcotics Safety Act requires patients to show photo ID to both their prescribing doctors and pharmacists before they can have prescriptions written and filled.  This new legislation combined with OxyContin’s reformulation has made it increasingly difficult to get enough of the drug to feed an addiction.

OxyContin addicts are now turning to its cheaper and more easily accessible cousin, heroin.

Heroin is similar to OxyContin in that it’s part of the “opioid” family of drugs.  Both narcotics produce euphoria-like highs and many users seek its effects to temporarily numb both physical and emotional pain.  But the effects of heroin are much stronger and more destructive.

The initial “rush” felt by new heroin users is a more powerful high than that produced by OxyContin.  The user is often propelled to consume increasingly larger quantities of the drug in an attempt to replicate that high, placing them at risk of overdose.  It’s this pursuit that makes heroin so dangerous.  And when the drug is not available, the accompanying withdrawal symptoms are intense and can drastically alter mood and behaviour.

Street value and availability of heroin has also changed considerably.  Ten years ago, heroin was a very different product.  It was more expensive ($50-$150 a bag), less pure and difficult to find.  Now we are seeing a steady supply being sold, at a fraction of the cost, that is 3-4 times more pure –the current street price for a bag is $10-$30.

Not only has the drastic drop in street value made it more accessible, but its purity has made it more attractive.  Ten years ago, a bag of 2-3% heroin had to be cooked and injected to attain a powerful high.  New supplies with 7-10% purity can be smoked or snorted – similar to cocaine. This opens up a much wider group of users who shy away from using a needle.

While well intentioned, the steps taken by Canadian and American drug companies and legislators likely played a part in creating a potential heroin crisis affecting populations in ways and numbers like never before.

The new user is often young, educated, and for many readers of this article, more like you than you think.

– 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

A Contrast to Psychiatry: The ‘Hearing Voices’ Movement

A Contrast to Psychiatry: The ‘Hearing Voices’ Movement

00Conformity, Education, Featured news, Health, Identity, Psychiatry, Therapy May, 15

Source: Oiluj Samall Zeid / Flickr

The 1961 classic, The Myth of Mental Illness by Thomas Szasz, revolutionized the way we think about atypical mental phenomena.

And over the years, the diagnosis of schizophrenia has been criticized fervently, with some characterizing it as an umbrella term for separate psychological phenomena that vary in combination and severity from person to person.

Critics of the term have described the way experiences such as hearing voices are conceptualized and defined.  The International Hearing Voices Network (Intervoice) views hearing voices as a normal variation in human experience—albeit one of an unusual nature.

Representing a lesser known view within the field of mental health, the group encourages voice hearers to “accept that the voices are real, and to accept that the voices may have meaning (metaphoric or literal) based on one’s life experiences.”

In the interest of communicating different (and sometimes controversial) ideas in mental health, The Trauma & Mental Health Report recently spoke with a mental health nurse (who requested anonymity), whose current research examines voice-hearers’ narratives about their emotional experiences.  While not a member of Intervoice, the interviewee’s research represents an alternate approach to traditional psychiatry.

 Q:  Can you explain the structure and method of the narrative approach you are working on?

A:  Put at its most basic, I am following the method called ‘Dialogical Narrative Analysis’, outlined by Sociologist, Arthur Frank.  In my work, Dialogical Narrative Analysis examines the stories that voice-hearers have about their emotions and what those stories do for them.

Q:  How best do you think these experiences should be conceptualized if not as psychopathological?

A:  It would be best to ask those with the experience.  At the moment it seems as though they are greatly helped when they don’t dismiss their experiences as ‘illness’, but engage with them as meaningful.  Having seen the prolonged effects of both approaches over a number of years, I can say that it’s the voice-hearers and those with unshared beliefs [what we usually refer to as delusions] who clearly have the most to teach us.

Q:  Supporters of drug interventions often explain the use of pharmaceuticals for treatment as diminishing the occurrences of delusions or hallucination.  Can you comment on this way of thinking?

A:  It’s a normalizing practice; it seeks to return outliers to a normal.  I’m hardly the first to point out that what is considered normal is subject to extreme change.  This is how we get situations where persons and behaviours are rated as mad in one generation and acceptable in the next— like having a baby outside of marriage, or homosexuality.  This leads some in the Hearing Voices Movement to hope that what happened to the identity of being homosexual can happen to the identity of being a voice-hearer.

Q:  Does this point out a flaw in our cultural and scientific understanding of the meaning of ‘delusion’ and ‘hallucination’?

A:  The word ‘delusion’ is a judgment, and in the Hearing Voices Movement they tend to prefer the term ‘unshared belief’.  Many would agree that the problem with a ‘delusion’ is not so much in thinking, but in the interaction with humanity.  ‘Hallucination’ also implies a shared version of ‘real’ experiences which would be difficult to justify, a concept of normal which is utopian.

Many within the Hearing Voices Movement reject both terms.

Q:  Should therapeutic efforts end with the attempt to remove the occurrences of hallucinations or delusions?

A:  I think you can see now that I am not altogether in favour of ‘therapeutic efforts’.  Too often there is a lot of therapeutic effort, a lot of money, a lot of well-meaning people, and not very much thinking.  I am quite certain I would not like to be on the receiving end of ‘therapeutic efforts’.  I would like there to be justice and healing in communities.

Even if we were to know the complete neurological makeup of a voice-hearer’s brain, we would still lack true insight into the actual experience of hearing voices.  Understanding and accepting the lived experiences of these individuals is an indispensable tool for promoting coping and recovery.

It allows us to see the distressed individual not as some ‘gene-machine’ gone wrong, but a human who bears a certain relationship to himself and the world.

– 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

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Treatments Available to Long Term Abduction Victims

10Animal Behavior, Cognition, Depression, Dreaming, Family Dynamics, Featured news, Health, Parenting, Psychiatry, Psychoanalysis, Sleep, Stress, Therapy, Trauma April, 15

Source: artmajor24//Flickr

Between 2002 and 2004, 16-year-old Amanda Berry, 21-year-old Michelle Knight, and 14-year-old Georgina DeJesus were abducted from the streets of Cleveland, Ohio. They were lured into the home of Ariel Castro where they spent the next 11 years in captivity.

Often kept in restraints and locked rooms, the women regularly had their lives threatened to deter any plans of escape.  They were given little food or the opportunity to bathe. Sexual abuse led to Knight being impregnated several times, only to be beaten and starved in order to force miscarriage.  It wasn’t until May 2013 that the women were finally rescued and Castro arrested.

Other cases popularized by the media include that of Elizabeth Smart, held captive for 9 months, and Jaycee Dugard who was held captive for 18 years. These victims are now free, but living with the emotional aftermath.

In a 2000 study by the Department of Neurological and Psychiatric Sciences at the University of Padova, interviews with kidnap victims showed common after-effects of abduction including vivid flashbacks of the events, nightmares, and feelings of depression, all common symptoms of Post-Traumatic Stress Disorder.  Hypervigilance was also reported, where individuals anticipated danger and frequently felt guarded, leading to trouble sleeping, eating, and social withdrawal due to difficulty trusting others.

Mental health professors David A. Alexander and Susan Klein, from the Aberdeen Centre for Trauma Research in the UK also add that some victims end up “shutting off’ their emotions or denying that they even experienced a traumatic event, which may stem from a desire to avoid anything that reminds them of their trauma.

How does someone this traumatized even begin to recover?  Clinicians who work with these victims help them find opportunities to make their own decisions, to slowly understand that they are no longer powerless.

Clinical psychologist Rebecca Bailey, therapist to Jaycee Dugard, is the author of, “Safe Kids, Smart Parents: What Parents Need to Know to Keep Their Children Safe.” In an interview with the Trauma and Mental Health Report, Bailey explained: “Number one is helping victims find their voice.  When you’ve been kidnapped, so much of your world is about having choices made for you…From day one you have to give them choices for everything, Do you want a glass of milk, or do you want a glass of water? Things like that.”

Another important aspect to recovery is the role of the family.  It is through a strong connection with the family that the victim can feel safe, comforted, and empowered.  Bailey mentions “tribal meetings” with families soon after rescue to reunify both parties and create a support system. Through these family systems, further recovery is possible.

Specific therapeutic approaches for victim recovery really depend on the individual.  In some cases Cognitive Behavioural Therapy can be used, in other cases experiential therapy or a more psychodynamic approach can be implemented.  Common techniques used in therapy with kidnapping victims are role-playing, therapeutic pets, music, or even walking through the wilderness in an attempt to trigger underlying feelings that must be dealt with.

Often, different therapies are combined to see which works best for the individual. Bailey reminds, however, that client interaction with the therapist also has a large impact on recovery.

Bailey: The most important thing is for the therapist to be mindful, authentic, and purposeful. Counterproductive would be having a therapist who says very little.  This could almost reinjure [the victim] because they need a certain amount of modelling as well.

Modelling how to have an authentic healthy relationship—after the abusive one they had with their abductor—is crucial to helping the victim integrate aspects of normal everyday life.

Still, even with proper therapy and a strong support system, the trauma of being abducted and held captive for years is unlikely to be erased.  In the case of the young women in Cleveland, along with many others, the journey to recovery has been a challenging one, but one that has been described as worth taking:

“I may have been through hell and back, but I am strong enough to walk through hell with a smile on my face and my head held high,” says Michelle Knight in a YouTube video addressed to the public.  “I will not let the situation define who I am.  I will define the situation.”

– Contributing Writer: Anjali Wisnarama, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

Slavery

Human Trafficking Remains Widespread Form of Slavery

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

Source: Bruno Casonato//Flickr

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

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

Q:  What is human trafficking?

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

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

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

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

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

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

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

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

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

Q:  What are some barriers to receiving help?

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

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

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

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

Q:  How can we empower survivors?

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

Q:  What can the general public do?

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

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

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

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

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

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

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

Copyright Robert T. Muller

Photo Credit: Bruno Casonato//Flickr

This article was originally published on Psychology Today

Feature Image

Anorexia Affects More Men Than Previously Thought

10Bulimia Nervosa, Consumer Behavior, Diet, Eating Disorders, Featured news, Gender, Health, Psychiatry March, 15

Source: Federico Morando//Flickr

Zachary Haines was 16 years old when a physical examination put his 5’7”, 230-pound body within the obese range.  Soon after, Zachary began working out and watching his diet, entering his junior year at high school 45 pounds lighter.

But what started as a healthy lifestyle soon spiralled into a struggle with anorexia nervosa, an eating disorder characterized by severely restricting food intake.  Like many other men and boys, Zachary’s extreme weight loss was not identified as an illness.  In fact, it was ignored until he was hospitalized for malnutrition.  Despite having many of the telltale signs of anorexia, Zachary’s condition went untreated.

Anorexia and bulimia are traditionally seen as “female problems.”  But, recent studies show that approximately one third of people with anorexia and about one half of those with bulimia are men.

One of the  influences thought to impact these men are the shifting ideals in the media that are putting pressure on men to become thinner.

While there may not be a direct causal relationship between media portrayals of the ‘ideal’ man and the development of eating disorders, these depictions contribute to a cultural context that glorifies their apparent normalcy.   They may also influence males’ fears of becoming overweight, as male models face pressure to slim down and appear androgynous.

The thin ideal male image is also making its way into fashion.

In 1967, an average mannequin’s dimensions were a 42-inch chest and a 33-inch waist.  Today’s average dimensions are a 35-inch chest and a 27-inch waist.  With the average American man’s waist size being 39.7 inches, these changes represent a remarkably unrealistic objective.

For Zachary, fitting into smaller sized clothing after weight loss was a source of pride.

But during treatment this once enjoyable activity became emotionally painful:  In Zachary’s words, “The most anxiety-inducing part for me is trying on clothes.  If I go up a size, I think I’m going to be 230 pounds again.”

The signs that something was wrong were all there.

Despite working out for three hours per day while only consuming 1,400 calories, Zachary was continuously trying to lose more weight.  By relying on inaccurate results from the Body Mass Index (BMI), doctors missed his emaciation.  He had never fallen into the anorexic range because the BMI does not take into account the proportion of muscle to fat, even though his emaciation would have been evident if he were seen shirtless.

The growing number of stories like Zach’s has led to significant changes to how anorexia nervosa is diagnosed.

In the DSM-V (the most recent version of American psychiatry’s diagnostic manual), this change involved eliminating Criterion D, or amenorrhea (the absence of menstruation) to make the diagnosis gender-neutral.

Zachary recovered because he had support from his family and friends, private insurance, and access to physicians and psychiatrists, who he worked with closely.

To help his recovery, he had to change his wish to pursue becoming an athletic trainer to that of going into advertising.

Those without resources can also identify some of the signs of an eating disorder:  extreme exercise behaviors, compulsive thoughts of losing weight, constantly feeling cold, and extreme food restriction.

These signs don’t discriminate between men and women, neither should we.

– Contributing Writer: Danielle Tremblay, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

Photo Credit: Federico Morando//Flickr

This article was originally published on Psychology Today

love is war, feature2

Love Is War: Post Infidelity Stress Disorder

00Anger, Attention, Cognition, Dreaming, Empathy, Featured news, Health, Hormones, Infidelity, Memory, Post-Traumatic Stress Disorder, Relationships, Self-Esteem, Sex, Sleep, Stress, Trauma March, 15

Source: Daquella manera/Flickr

Blind-sided by the one you love, the one you married.

Learning about your spouse’s infidelity can be emotionally and physically devastating. The emotional damage is reflected in what some mental health professionals call Post-Infidelity Stress Disorder (PISD), for the stress and emotional turmoil experienced afterward.

Psychologist Dennis Ortman, author of Transcending Post-Infidelity Stress Disorder, describes the term as “not to suggest a new diagnostic category but to suggest a parallel with post-traumatic stress disorder, which has been well documented and researched.”

In Post-Traumatic Stress Disorder (PTSD), re-experiencing the trauma repeatedly is the first of three categories of symptoms described. The disorder is marked by flashbacks of war for veterans, nightmares of the accident for car wreck survivors, and painful memories of abuse for survivors of intra-familial trauma.

So too, in PISD husbands and wives will replay the painful realization of betrayal.  Even after the initial fall-out, people will have recurring thoughts of their partner with another.

Psychologist and certified sex therapist, Barry Bass, adds, “Like trauma victims, it is not unusual for betrayed spouses to replay in their minds previously assumed benign events,” those times when their spouse became defensive when asked a simple question, or the late nights at work, or the text messages from unnamed friends, all of these become viewed as possible deceitful acts.

The second category of symptoms for PTSD, avoidance and emotional numbing, is seen in PISD as well.  Rage or despair that comes after the initial shock of discovering the infidelity can be followed by a state of emotional hollowness.  Formerly pleasurable activities lose their appeal.  Those who were cheated on sometimes withdraw from friends and family and describe feelings of emptiness.

The last category of PTSD symptoms, hyper-vigilance and insomnia, can also arise for those dealing with infidelity.  Sleep patterns become erratic; and concentration becomes a challenge, affecting work performance and family life.

PISD can have physical consequences as well as emotional ones.  The stress of discovering infidelity can lead to what has been dubbed broken heart syndrome, also termed stress cardiomyopathy.  The American Heart Association describes symptoms such as sudden chest pain, leading to the sense that one is having a heart attack.  Physical or emotional stressors, such as a loved one passing or major surgery trigger a surge of stress hormones that temporarily affect the heart.  The condition typically reverses within a week.

Despite the stress, there is life after an affair.  Due to the symptomatic similarities, therapists are now beginning to use PTSD counseling techniques to help couples either stay together or move on.

Exposure and cognitive restructuring are techniques used when dealing with traumatic memories.  In exposure, spouses are asked to gradually imagine those heart-wrenching moments and to cope with them gradually, whereas cognitive restructuring substitutes irrational thoughts, feelings, and behaviours induced by the trauma, with adaptive ones.

Counselors use these “trauma focused” explorations with clients, sifting through the distressing memories and aversive feelings, to help build the client’s self-esteem and confidence in dealing with the betrayal or loss of the relationship.

Therapists are also working with their clients to help them understand the unique reasons that led to the infidelity.  Understanding why the affair occurred can help both people.

Along with help from family and friends, wounds can be bandaged and trust restored.  Infidelity trauma and the time and strength involved in recovery remind us that love, like war, can have its casualties.

– Contributing Writer: Justin Garzon, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

Photo Credit: Daquella Manera/Flickr

This article was originally published on Psychology Today

Brain Trauma, feature2

Coping With Traumatic Brain Injury

10Anxiety, Child Development, Cognition, Depression, Empathy, Environment, Featured news, Health, Memory, Neuroscience, Productivity, Sleep, Sport and Competition, Trauma February, 15

Source: Shine In Your Crazy Diamond//Flicker

Traumatic brain injuries (TBI) contribute to many deaths each year, and can lead to the development of secondary mental health problems.  The Centre for Disease Control has reported that approximately 1.7 million TBIs occur every year, and individuals with a TBI commonly suffer cognitive impairments and developmental delays.

The Trauma & Mental Health Report recently spoke with Tricia Williams, a clinical neuropsychologist at Holland Bloorview Kids Rehabilitation Hospital, who works with children who have different forms of TBI.  Williams explained how to improve child development and mental health for individuals coping with a TBI.

Q:  What are the most common injuries that lead to the development of a TBI?

A:  A TBI is caused when an external mechanical force, such as a blow to the head or a concussive force causes harm to the head or body.  Motor vehicle accidents are the leading cause of TBIs.

Other common injuries include falls (which are common in young children and infants), sport injuries, concussions, horseback riding, interpersonal violence (fighting, gun shots, physical hits to the head by person/object,) and war related injuries.

Q:  How is a TBI diagnosed?

A:  Professionals in emergency services diagnose a TBI in the acute state at the time of injury.  They assess the severity of the injury by checking eye responses, verbal responses, motor responses, and mobile ability.  CT scans are initially performed to rule out bleeding and swelling, and then an MRI may be performed as follow up.  Amnesia is another way to diagnose a TBI. The degree of memory loss prior to the event, and difficulty forming new memory can provide more information about the injury. The duration of loss of consciousness can also affect the severity of the injury, which may be ranked as either mild, moderate, or severe.

Q:  What is involved in rehabilitation following a TBI?

A:  In the acute state, the TBI is managed medically, including neurosurgical intervention.  Once stabilized at the hospital, children move on to rehabilitation.  An assessment of physical, functional, and speech abilities are conducted, and occupational therapists and speech and language pathologists then work with the children. Neuropsychological assessments are conducted after the acute state to help children transition back to school.  The children continue with follow-up visits to monitor the impact of the injury on developing cognitive skills.

Q:  As a clinical neuropsychologist, what is your role with patients who have a TBI?

A:  Children are seen as inpatients at the hospital after the injury, and are also seen as outpatients after they have transitioned home.  They can be followed for many years after the injury.  Typically, they are seen during transitional periods such as the transition from primary school to high school.  A thorough assessment of the child’s skills (IQ, memory and learning, language, processing speed, executive functioning, academic skills, visual and motor skills, socio-emotional status) are conducted and compared to previous testing to assess the child’s progress and developing difficulties.

Q:  What daily activities can become difficult for an individual with a TBI?

A:  Activities that can be difficult depend on the nature and severity of the injury, the stage of recovery, and how well they have been supported.  Common complaints across all injuries include:  keeping up with class, forgetfulness, difficulty paying attention, and becoming easily fatigued, overwhelmed, and frustrated.  Because these activities can be challenging, continued support from their physicians and neuropsychologists as well as family support is very important during the recovery process.

Q:  How can secondary mental health symptoms develop from a TBI?

A:  Depression is a common outcome, and can develop as a reaction to the injury or to neurochemical changes in the brain.  Anxiety is also a common reaction to the injury, because if the child is old enough to understand what has happened, they might expect it to happen again.  This is common for children who developed a TBI as a result of a sports injury.  Children can also be anxious about their academic achievement and about performing well in school.  It is important to make patients aware of potential secondary mental health symptoms. But, individuals with a TBI can also have a greater appreciation of life, as they see themselves as survivors.

Q:  What advice can you offer someone with TBI?

A:  Be patient with yourself and try to normalize your emotional variability.  It’s important to ask for and accept help, and to find the balance between accepting what has happened and moving on.  Individuals should keep in mind that while there are variable outcomes, full recovery is possible.  Finding a “new normal” for oneself without becoming centered on the injury is extremely important.

Q:  Do you have any further suggestions for coping with a TBI?

A:  Here is a list of helpful tips:

  • Take additional time on activities as needed
  • Manage fatigue (with exercise/relaxation, sleep)
  • Ask for repetition of key information and written outlines of key terminology
  • Repeat back what people tell you to ensure you are understanding
  • Use your phone or equivalent to make dictated notes and reminders with regularly scheduled playback times
  • Break down (or ask someone to help you break down) larger tasks into smaller manageable parts
  • Choose the time of day when you are most able to accomplish tasks that require more obvious mental effort and sustained attention
  • Recognize the signs that you are losing attention/productivity or becoming overwhelmed and take a break
  • Exercise can help relieve tension, improve sleep and attention
  • Seek out a quiet room to complete work or practice techniques as needed
  • Social support is extremely helpful

Traumatic brain injuries (TBI) contribute to many deaths each year, and can lead to the development of secondary mental health problems.  The Centre for Disease Controlhas reported that approximately 1.7 million TBIs occur every year, and individuals with a TBI commonly suffer cognitive impairments and developmental delays.

The Trauma & Mental Health Report recently spoke with Tricia Williams, a clinical neuropsychologist at Holland Bloorview Kids Rehabilitation Hospital, who works with children who have different forms of TBI.  Williams explained how to improve child development and mental health for individuals coping with a TBI.

Q:  What are the most common injuries that lead to the development of a TBI?

A:  A TBI is caused when an external mechanical force, such as a blow to the head or a concussive force causes harm to the head or body.  Motor vehicle accidents are the leading cause of TBIs.

Other common injuries include falls (which are common in young children and infants), sport injuries, concussions, horseback riding, interpersonal violence (fighting, gun shots, physical hits to the head by person/object), and war related injuries.

Q:  How is a TBI diagnosed?

A:  Professionals in emergency services diagnose a TBI in the acute state at the time of injury.  They assess the severity of the injury by checking eye responses, verbal responses, motor responses, and mobile ability.  CT scans are initially performed to rule out bleeding and swelling, and then an MRI may be performed as follow up.  Amnesia is another way to diagnose a TBI. The degree of memory loss prior to the event, and difficulty forming new memory can provide more information about the injury. The duration of loss of consciousness can also affect the severity of the injury, which may be ranked as either mild, moderate, or severe.

Q:  What is involved in rehabilitation following a TBI?

A:  In the acute state, the TBI is managed medically, including neurosurgical intervention.  Once stabilized at the hospital, children move on to rehabilitation.  An assessment of physical, functional, and speech abilities are conducted, and occupational therapists and speech and language pathologists then work with the children. Neuropsychological assessments are conducted after the acute state to help children transition back to school.  The children continue with follow-up visits to monitor the impact of the injury on developing cognitive skills.

Q:  As a clinical neuropsychologist, what is your role with patients who have a TBI?

A:  Children are seen as inpatients at the hospital after the injury, and are also seen as outpatients after they have transitioned home.  They can be followed for many years after the injury.  Typically, they are seen during transitional periods such as the transition from primary school to high school.  A thorough assessment of the child’s skills (IQ, memory and learning, language, processing speed, executive functioning, academic skills, visual and motor skills, socio-emotional status) are conducted and compared to previous testing to assess the child’s progress and developing difficulties.

Q:  What daily activities can become difficult for an individual with a TBI?

A:  Activities that can be difficult depend on the nature and severity of the injury, the stage of recovery, and how well they have been supported.  Common complaints across all injuries include:  keeping up with class, forgetfulness, difficulty paying attention, and becoming easily fatigued, overwhelmed, and frustrated.  Because these activities can be challenging, continued support from their physicians and neuropsychologists as well as family support is very important during the recovery process.

Q:  How can secondary mental health symptoms develop from a TBI?

A:  Depression is a common outcome, and can develop as a reaction to the injury or to neurochemical changes in the brain.  Anxiety is also a common reaction to the injury, because if the child is old enough to understand what has happened, they might expect it to happen again.  This is common for children who developed a TBI as a result of a sports injury.  Children can also be anxious about their academic achievement and about performing well in school.  It is important to make patients aware of potential secondary mental health symptoms. But, individuals with a TBI can also have a greater appreciation of life, as they see themselves as survivors.

Q:  What advice can you offer someone with TBI?

A:  Be patient with yourself and try to normalize your emotional variability.  It’s important to ask for and accept help, and to find the balance between accepting what has happened and moving on.  Individuals should keep in mind that while there are variable outcomes, full recovery is possible.  Finding a “new normal” for oneself without becoming centered on the injury is extremely important.

Q:  Do you have any further suggestions for coping with a TBI?

A:  Here is a list of helpful tips:

Take additional time on activities as needed
Manage fatigue (with exercise/relaxation, sleep)
Ask for repetition of key information and written outlines of key terminology
Repeat back what people tell you to ensure you are understanding
Use your phone or equivalent to make dictated notes and reminders with regularly scheduled playback times
Break down (or ask someone to help you break down) larger tasks into smaller manageable parts
Choose the time of day when you are most able to accomplish tasks that require more obvious mental effort and sustained attention
Recognize the signs that you are losing attention/productivity or becoming overwhelmed and take a break
Exercise can help relieve tension, improve sleep and attention
Seek out a quiet room to complete work or practice techniques as needed
Social support is extremely helpful

– Contributing Writer: Janany Jayanthikumar, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

Photo Credit: Shine In Your Crazy Diamond//Flickr 

This article was originally published on Psychology Today

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

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

Source: conrado/Shutterstock

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

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

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

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

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

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

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

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

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

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

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

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

It sells.

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

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

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

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

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Methadone Treatment May Prolong Addiction

00Addiction, Diet, Environment, Fear, Featured news, Health, Motivation, Psychopharmacology, Resilience, Sleep, Spirituality, Stress, Trauma January, 15

The conventional treatment for opioid dependence is to prescribe methadone.

Similar to morphine, methadone is a synthetic opioid sometimes referred to as a narcotic. It is useful at preventing opioid withdrawal, minimizing drug cravings, and is said to reduce the risk of HIV, Hepatitis C and other diseases associated with intravenous drug usage. Methadone is also cheap, and best of all legal.

Despite the advantages, methadone is highly addictive, and has many side effects such as dry mouth, fatigue, and weight gain.

Treatment involving methadone requires a weekly medical visit to renew the prescription, sometimes leading those who are addicted back to the very environment and people that they need to avoid to stay clean.

The Trauma & Mental Health Report recently spoke with Leslie (name changed for anonymity), a patient who has been receiving methadone maintenance treatment (MMT), who says, “Sometimes I wait all day to see the doctor. During that time, you can’t help but associate with other users, hear “drug talk”, or even see drugs being passed around. The methadone doctor doesn’t push counseling and is not there for support. I’m only going to get my prescription.”

Toward the end of treatment, methadone dose is slowly tapered to prevent withdrawal. But most users don’t wean off completely. Leslie says she didn’t have the motivation or tools to do so until she started seeing her drug addictions counselor:

“I’ve been trying to get off of methadone for 18 months now. It has helped with the withdrawal symptoms, and life is easier to manage since I’m not running the street 24/7 looking for my next fix. And I have more time to get my life on track. But, In order to ‘knock’ the addiction you need to figure out what your personal triggers are. My counselor has helped me with this. She also provides a safe place for me to go and discuss my problems and any issues I have with MMT.”

The greatest fear is relapse. Although part of the recovery process, relapse can have physical and emotional consequences. But it helps to identify personal triggers: cues that provoke drug-seeking behavior, the most common of which are stress, environmental factors such as certain people or places, and re-exposure to drugs.

The most important missing link in MMT is drug counseling. Meeting with a counselor is not mandated and patients seldom see one. Those who seek counseling benefit from help determining personal triggers, and preparing for potential relapse. A counselor may help create a healthy living plan that focuses on improving mental health with nutrition, exercise, sleep, building healthy relationships, and spiritual development.

Better family relationships also help with recovery. Including family members in treatment increases commitment to counseling and also helps family members understand what the person is going though.

Opioid addiction is more than physical dependence. Initial detox is a start. Methadone helps with the physical aspects of withdrawal, and helps users lead a more normal life. But without the help of a drug counselor, MMT isn’t enough.

Without counseling, social support, a drug free environment, and the desire to change, we lead the patient only part way there. And part way isn’t enough.

– Contributing Writer: Jenna Ulrich, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

Photo Credit: www.123rf.com/stock-photo/lonely_man.html

This article was originally published on Psychology Today

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Myth Busting the Not Criminally Responsible Defense

00Altruism, Empathy, Ethics and Morality, Featured news, Guilt, Health, Law and Crime, Psychiatry, Psychopathy, Psychopharmacology, Therapy, Trauma December, 14

“I thought he must die. He had no future, nothing good. I thought I was saving the child.”

Nerlin Sarmiento had expressed disturbing thoughts about her children long before tragedy struck her small family of four. On many occasions the 32-year-old Edmonton mother had confessed to doctors and family members that she had thoughts of harming herself and her children.

Precautions were taken: Sarmiento was admitted to hospital several times, prescribed psychiatric medication, discharged, and had her mother move in to help care for the children. 

On the morning of February 12th 2013 in Edmonton, Alberta, Sarmiento sent her ten-year-old daughter to school, then forced her seven-year-old son into the bathroom where she held him under water until he stopped breathing.

Sarmiento did not deny murdering her son. She called the police herself to report the crime. Her lawyers, however, argued that she should not be held responsible on account of her mental illness that prevented her from appreciating the moral wrongfulness of her actions.

Two psychiatrists testified at Sarmiento’s trial. They explained that she was experiencing a severe depressive episode as part of her previously diagnosed bipolar disorder. She felt despair so extreme she became convinced she was committing an altruistic act, saving her son from a life of predestined poverty and hardship. 

On September 12th, 2013, Justice Sterling Sanderman agreed. Nerlin Sarmiento was found not criminally responsible (NCR) on a charge of first-degree murder. 

The public outcry against the ruling was reminiscent of the aftermath of the Vincent Li and Guy Turcotte trials; they were found NCR on charges of second-degree murder and first-degree murder respectively.

NCR has been a hot topic featured prominently in the press following several high profile cases, but is often misunderstood.

In Canada, if the court decides that an individual has committed a criminal act (i.e., they are guilty), but lacked the capacity to know that their actions were not only criminally wrong, but also morally wrong at the time, a verdict of not criminally responsible may be given.

Psychiatrist Robert Dickey with Correctional Service Canada and the University of Toronto helped the Trauma & Mental Health Report gain a better understanding of NCR and bust some of the myths surrounding the defense. 

Myth 1: Almost anyone can claim they have a mental disorder and use the NCR defense.

Technically, this is true. But whether or not they would be successful is another story, says Dickey, explaining that if you don’t have a severe mental illness, it is very hard to malinger your way through an NCR assessment and defense.

He further explains that the finding of NCR is based on the exact mental state of the accused at the time of the crime. By the time someone is referred for assessment by the courts, their state of mind may be quite different than it was when the offense was committed. 

A good clinician will seek clear corroborating information that the individual was suffering from a psychotic illness at the time they were arrested. The police, jail and institutional records should give information as to the individual’s mental state at the time.

This is not a matter of being a little depressed, states Dickey. The individual must be so ill that they would not have been able to tell right from wrong, appreciate the wrongfulness of their actions or engage in rational choice when the crime occurred.

Myth 2: The NCR defense is a tactic for offenders to skirt the justice system.

Mostly false, says Dickey. If an individual does not suffer from a psychotic illness, pure psychopathy or criminality alone is not considered – by the law – to be a disease of the mind severe enough to qualify for a finding of NCR.

If the NCR defense is successful, the individual is remanded to the custody of the Provincial Review Board, where the offender is encouraged to receive treatment. Interestingly, the board itself has no power to order the accused to engage in treatment. 

But if an accused does refuse, they are often detained in a secure facility. Dickey explains that with cases of major mental illness and the refusal of treatment, the physician can refer the offender to the Consent and Capacity Review Board. And the individual may be declared incapable to refuse psychiatric treatment and treated against their will.

Myth 3: When a person is found NCR for a crime, they essentially walk free. 

False. The vast majority of offenders found NCR spend a lot more time detained in a secure facility than if they had been found guilty and served a regular prison sentence, Dickey explains. Because the consequences of NCR are more restrictive and more ensuring of treatment, the issue is now more readily raised by the crown (prosecution) than the defense.

After the individual has been remanded to the Provincial Review Board, the forensic psychiatrist will testify as to the necessary level of security needed to manage the offender and their psychiatric care, while still ensuring the safety of the community.

So what’s in store for Nerlin Sarmiento?

When her trial concluded, she was remanded to the custody of the Alberta Review Board (ARB). At a hearing within 45 days from the end of her trial, the ARB determined whether she would receive an absolute discharge, a conditional discharge or be detained in custody. The results of Sarmiento’s hearing have yet to be made public.

 – Contributing Writer: Jennifer Parlee, The Trauma and Mental Health Report

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

 Copyright Robert T. Muller

Photo Credit: Shutterstock

This article was originally published on Psychology Today