Category: Therapy

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Remote Northwest Territories Lacking Mental Health Care

00Environment, Featured news, Health, Self-Harm, Suicide, Therapy, Trauma November, 16

Source: Gloria Williams on Flickr, Creative Commons

On April 26, 2015, 19-year-old Timothy Henderson, a resident of the North West Territories in Canada, was taken off life support after sustaining self-harm injuries, the culmination of a long battle with depression and other mental health issues.

Beginning in adolescence, Timothy struggled with symptoms of ADHD and Asperger’s syndrome (Autism spectrum). When he felt overwhelmed by his condition, he reached out for support, but felt dismissed, and began to lose hope that the help he needed would be available.

Shortly before his death, Timothy admitted himself to Stanton Territorial Hospital for the fifth time in a year, where he again disclosed details about a tendency to self-harm. He was released two days later, without adequate follow-up or a long-term care plan. Later that month, he sustained self-inflicted injuries that led to his death.

Timothy’s case is not uncommon in the Northwest Territories, a remote region of northern Canada. The NWT Mental Health Act states that a medical practitioner can only detain an individual for psychiatric assessment for a maximum of 48 hours. This time limitation often results in rushed and insufficient care—a result of a system that is understaffed and overworked.

The territory’s current Mental Health Act, introduced in June 1988, has been cited as a main cause of inadequate services for individuals suffering from mental illness. The act is out-of-date and has not been modernized with strategies to address the current mental health climate of the NWT.

In a report by the Alternative North Health Coalition, the mental wellbeing of residents in the NWT is shown to be much lower than that of the average Canadian, with a national rate of suicide three times greater than those living in the more populous south. Lack of access to staff, resources, and community-based treatments are all relevant aspects of the act that impede adequate treatment and prevention strategies.

Timothy’s mother, Connie Boraski, believes Timothy’s mental health began to worsen when he turned 17, and no longer qualified for the pediatric healthcare program. This transition resulted in lengthier waits for treatment and drastic changes in privacy laws that prevented Timothy’s parents from having access to information about their son’s treatment. Mental health legislation regarding the legal rights of family members and other caregivers is an aspect of the Mental Health Act that restricts parents, like Timothy’s, from intervening to support their children.

After being repeatedly dismissed, Timothy eventually stopped asking for help. Boraski explains:

“Timothy never wanted to be a burden to anyone. That was a real challenge for him, to ask for help.”

Deficiencies in the quality and quantity of staff and resources reflect the isolation and socioeconomic climate of the NWT. Due to the small and relatively isolated nature of the region, accessing facilities within the community can be difficult. Timothy had to travel between hospitals in the NWT and Alberta to obtain psychiatric help, which resulted in seeing a different doctor on each occasion. This kind of disjointed doctor-patient relationship makes it difficult to stay connected.

The public outrage following Timothy’s death eventually drove NWT Health Minister, Glen Abernethy, to open a review into Timothy’s case and bring changes to mental health legislation. In addition to other important components, the new act will include information on services such as Assertive Community Treatment (ACT), which will allow patients to have access to specialized treatment and supervision within remote communities of the NWT.

The revised act, if passed, is expected to come into effect sometime in 2016. Though implementation of a new mental health act is too late for Timothy Henderson, the hope is that a new mandate will provide the Northwest Territories with better preventative measures and resources for residents suffering with mental illness.

– Nonna Khakpour, Contributing Writer, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Illustrating Mental Health with Cartoons

00Charisma, Creativity, Depression, Featured news, Health, Humor, Therapy November, 16

Source: Allie Brosh

From the darkness of despair, Gemma Correll and Allie Brosh have created deeply personal cartoons to illustrate their experiences with mental illness. Maintaining popular online blogs, they have recently published cartoon books revealing their innermost struggles and fears.

Through simple drawings, Correll and Brosh make it easy for audiences to grasp the intricate aspects of psychological disorders. The unique illustrations are designed to be informative, yet dark and humorous.

In her 2015 book, The Worrier’s Guide to Life, Correll portrays her experience with anxiety, including unwanted intrusions from unexpected guests and unwelcome phone calls that one would prefer to avoid. She labels them “Real Life Horror Movies.”

Another example of Correll’s sharp humour comes in the form of a red poster, shouting: “I can’t keep calm and carry on because I have an anxiety disorder.”

Though the images are vital to the message, the corresponding narratives are equally important. Correll explains her images only make sense in combination with the words. One poignant cartoon called “Visit Depression Land! It’s the crappiest place on earth,”depicts a “non” amusement park with commentary on all of the “non” amusing things you can do while visiting.

The comics are both painful and funny. One of Correll’s fans sums up the experience on Twitter: “I’m laughing but I’m also crying. But I’m also laughing.”

A common thread in the struggle with mental illness is the accompanying isolation; in these comics, readers see themselves and their situations, and perhaps realize that they are not alone in the experience. In an interview with NPR, Correll explains, “I think people are really glad to find somebody who’s had the same kind of experience. Anxiety and depression can make you feel quite isolated.”

This sentiment was echoed by Brosh in an online Reddit question and answer session:

“Depression is such an isolating experience, but there’s always a tiny amount of comfort from knowing that someone else has been out there too. I mean, I never thought that writing about my depression would circle back around and make me feel less isolated, but in a strange way, it has.”

Although depression can be difficult to explain, Brosh chronicles it with startling clarity in her blog Hyperbole and a Half:

“I spent months shut in my house. I couldn’t feel anything through the self-hatred. Trying to use willpower to overcome the apathetic sort of sadness that accompanies depression is like a person with no arms trying to punch themselves until their hands grow back.”

In another blog entry with an accompanying cartoon, Brosh captures how depression feels:

“You’re stuck in the boring, lonely, meaningless void without anything to distract you from how boring, lonely, and meaningless it is.”

Brosh painstakingly works to get the facial expressions and body stances of her characters just right, to depict the emotions she wants to convey. Visual cues give meaning where words fail.

Depression is often misunderstood by those who don’t suffer from it. Many think that giving advice and imposing optimism are the answers. Brosh illustrates this disconnect.

Psychologists and professors are taking note—sharing the blogs widely and using them as teaching tools.

Psychologist Jonathan Rottenberg of the University of South Florida devoted a post on Psychology Today to Brosh:

“I know of no better depiction of the guts of what it’s like to be severely depressed. If you’ve been severely depressed, or if you know someone who is and you want to know more about what they are experiencing, please read ‘Hyperbole and a Half.’ “

Psychotherapist, psychology student, and Reddit user ‘busterbrother’ also explains on Reddit how the cartoons made a difference in her practice and at school. One of her suicidal clients struggling with depression felt that no one understood. Using Brosh’s blog, the therapist could offer an account of someone facing similar difficulties. ‘Busterbrother’ also used the blog in a presentation to illustrate depression to others in her cohort, after which her professor began incorporating it into his own classes:

“The professor said that this blog is the best way that he has ever seen someone talk about depression to someone who has never experienced it.”

This idea is supported by research. In the International Journal of Humor Research, Yan Piaw Chua, a professor at the University of Malaya in Malaysia, demonstrated how this type of humour can enhance student comprehension and motivation to learn. And studies show that humour can improve wellbeing and reduce depression.

Researchers Shelley Crawford and Nerina Caltabiano at James Cook University in Australia developed a humour skills program that included a booklet with jokes and funny stories. They found that participants achieved heightened wellbeing, as well as decreased depression and anxiety, in comparison to groups that received treatment without humour or no treatment at all. Other studies have shown similar results.

As one reader put it: “…these comic strips make my day whenever I am feeling a little glum and need an instant pick-me-up.”

Being able to communicate feelings of depression and anxiety without being judged, and doing so creatively… what better way to combat demons?

–Lysianne Buie, Contributing Writer, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Biased Publication Standards Hinder Schizophrenia Research

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

Source: Erin on Flickr

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

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

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

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

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

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

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

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

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

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

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

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

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

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“Ex-Gay” Conversion Therapy Movement Puts Lives at Risk

00Conformity, Featured news, Health, Sexual Orientation, Social Life, Stress, Therapy September, 16

Source: Photographee.eu/Shutterstock

There is a billboard in Richmond, Virginia hanging above the interstate with a picture of identical male twins and a caption that reads: “Identical Twins: One Gay, One Not. We believe twin research studies show nobody is born gay.”

Parents and Friends of Ex-Gays & Gays (PFOX), the organization that created the ad, promotes the view that being gay is a choice, not a genetic predisposition, despite extensive research showing the contrary.

The claims in the ad are not only false, but the men featured are not actually twins at all, or even brothers. According to the Huffington Post, the face of South African model, Kyle Roux, was superimposed onto two different bodies to give the illusion of twins. Roux was shocked to see his face on the ad, as he didn’t give permission for the image to be used. And…he is openly gay.

PFOX is part of the controversial Ex-Gay Movement, encouraging gay persons to refrain from same-sex relationships, eliminate homosexual tendencies, and develop heterosexual desires. Their view: Gay must be cured.

They consider sexual orientation a choice, and those who identify as gay are willingly choosing a deviant lifestyle. But this ideology results in family rejection and self-hatred among LGBTQ individuals, as well as intolerance and discrimination in the community.

Organizations promoting this view are often affiliated with religious institutions. PFOX believes gay people can renounce homosexuality through religious revelations or conversion therapy, also known as reparative therapy.

Sexual orientation conversion therapy became popular in the 1960s. According to the American Psychological Association report, Appropriate Therapeutic Responses to Sexual Orientation, different disciplines of psychology influenced practices of conversion therapy.

In response to such treatments, numerous mental health and psychological organizations publically announced that homosexuality is not a mental disorder and is not something that can or should be cured. In fact, the American Psychiatric Association’s Board of Trustees removed homosexuality from the Diagnostic and Statistical Manual of Mental Disorders, Second Edition (DSM II) in 1973. And in 2000, they further stated:

“The potential risks of reparative therapy are great, including depression, anxiety and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient.”

The risks are even greater among gay youth. A 2009 study by Caitlin Ryan of San Francisco State University found that young adults who experience family rejection based on their sexual orientation are eight times more likely to attempt suicide and six times more likely to experience depression.

Despite these findings and professional opposition to conversion therapy by both the American Psychiatric and American Psychological Associations, many of these treatments continue to be used and promoted.

Michele Bachmann, a Republican former member of the U.S. House of Representatives, considers homosexuality a choice. Bachmann and her husband were found to be practicing conversion therapy at their Christian counseling clinic in Minnesota.

Conversion therapy is still legal in most U.S. states, though anti-conversion bills have been signed into law in California, New Jersey, and Washington DC. Campaigns such as the #BornPerfect movement are working toward expanding state bans into other areas.

While public attitudes and legislation are shifting toward respect for LGBTQ individuals, conversion therapy is still a common practice, compromising mental health, threatening lives, and undermining efforts of movements that stress tolerance and equality.

–Eleenor Abraham, Contributing Writer, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Exercising Your Way to PTSD Recovery

00Featured news, Health, Post-Traumatic Stress Disorder, Stress, Therapy, Trauma August, 16

Source: Wounded Warrior Regiment on Flickr

Recent headlines about suicide, domestic violence, and shootings have brought public awareness to the mental health strain that is placed on the men and women in our military.

Post-traumatic stress disorder (PTSD) can drastically alter the lives of sufferers and is particularly common in veterans. The condition has been documented in 8% of Canadian soldiers who served between 2001 and 2008 in Afghanistan.

Effects include flashbacks, high anxiety, personality changes, startle responses, mood swings, and disturbed sleep, with typical treatment involving antidepressants and psychotherapy.

In an effort to develop treatment options, many are looking to physical remedies such as intense exercise to help those suffering from PTSD. We know that those who exercise regularly are less likely to suffer from anxiety and depression. But research by Mathew Fetzner and Gordon Asmundson at the University of Regina found that two weeks of stationary biking can be helpful in reducing PTSD symptoms and improving mood.

Further, researchers at Loughborough University have reviewed multiple studies that looked at the impact of sport and physical activity on combat veterans diagnosed with PTSD. Their findings: physical activity enhances well-being in veterans by reducing symptoms and improving coping strategies.

Symptom reduction in these studies seems to occur through a renewed sense of determination and hope, increased quality of life, and the cultivation of positive self-identity. The researchers explain that participating in sports and physical activities helps combat veterans gain or regain a sense of achievement.

Exercise also increases respiratory sinus arrhythmia. This naturally occurring variation in heart rate is linked to higher levels of emotion-focused coping—an ability disrupted in those with PTSD.

Treatment adherence is often a problem for PTSD sufferers, given that formal therapy is not always appealing to them, Fetzner claims. Low dropout rates of therapies involving physical exercise make the intervention feasible.

But the positive effects of intensive exercise on PTSD may be suitable only for some combat veterans: those with the physical ability to participate.

According to Veterans Affairs in Canada, psychiatric conditions are the second-most common cause of disability among returning soldiers. Debilitating physical injuries, such as amputations, and traumatic brain and spinal chord injuries are more common. And in addition to PTSD, the two most common mental health problems among returning soldiers are substance abuse and depression. More than 80 percent of the time, combat veterans have more than one diagnosis.

While aerobic exercise significantly reduces depression symptoms and helps prevent the abuse of drugs, the high rates of physical impairment in returning soldiers complicates the optimistic picture of exercise’s benefits on PTSD.

Less physically demanding exercise may be an option. Recent research shows that yoga, for example, may help individuals with PTSD focus on the present, reduce rumination, and combat negative thinking patterns.

While strenuous physical exercise may only be helpful for some returning veterans, milder forms of exercise and physiotherapy may be a useful adjunct to traditional treatment for many others. In either case, it is important for researchers and clinicians alike to take note of alternative ways of treating PTSD in an effort to provide options to those affected with the debilitating disorder.

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

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

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At CAMH, Pet Therapy Helps Decrease Stigma

00Emotion Regulation, Featured news, Happiness, Law and Crime, Loneliness, Psychiatry, Therapy May, 16

Source: Ryan Faist, Used With Permission

When I tell others that I volunteer with my dog in a pet therapy program, they assume my work involves children or the elderly. I am not surprised: the benefits of animal-assisted therapy for these groups are widely known.

But my dog Rambo’s “patients” are quite different. He and I volunteer at an inpatient unit at the Centre for Addiction and Mental Health (CAMH) in Toronto. The people Rambo sees every Tuesday reside in the Secure Forensic Unit.

Accused of committing crimes ranging from shoplifting to homicide, these individuals all suffer from severe mental illness. Their treatment at CAMH is court-ordered, and they are routinely assessed by mental health professionals to determine if they can be held responsible for their crimes.

Theresa Conforti, the co-ordinator for Clinical Programs and Volunteer Resources at CAMH, explains how pets factor into the equation:

“For the past 10 years, CAMH has had their own Pet Therapy Program that is very unique and caters only to the clients at CAMH. The clients value the unconditional love and affection the dog gives them on a weekly basis. The importance is that this program bridges the gap for those who have had to leave their furry friends to come to treatment, and for those who will not be able to own a dog due to financial restrictions or housing situations. The weekly visits ease loneliness, improve communication, foster trust, decrease stress and anxiety, and are a lot of fun!”

The program assesses the volunteers for eligibility, while the dog goes through an evaluation with a professional service dog trainer. Conforti notes:

“This works because those interested in volunteering at CAMH are not here to stigmatize our patients, rather they are here to make a difference and di-stigmatize mental illness.”

To say the experience has been rewarding for volunteers like me would be an understatement. Patients are happy to see Rambo, talk to him, pet him, or just be in the same room with him. Not only does he give them a break from their daily routines and the confinement of their unit at CAMH, but he also offers unconditional affection to those in the program.

And while the benefits of pet therapy are numerous, unconditional affection is the critical point here.

When people find out where Rambo and I volunteer, I am often asked whether I fear for our safety, highlighting the common misconception that individuals with severe mental illness are dangerous and violent. Stereotypes like this further perpetuate mental illness stigmatization.

But animals do not judge. They do not care about physical appearance, diagnoses, or criminal history. Conforti recalls:

“One of our dogs went on a unit and a selective mute client—a client who chooses not to speak—had knelt down and whispered in the dog’s ear. No one heard what the client said to the dog, but it was the first time the client had ever spoken. And he had chosen to do so to a dog that will not judge nor will expect much from him. I love that story because it shows that dogs are there to help, love unconditionally, and, most importantly, they do not stigmatize.”

This may be one reason animal-assisted therapy programs are gaining popularity globally. A program in Bollate, Italy, has introduced the use of dog therapy for prison inmates. Valeria Gallinotti, the founder of the program, explains:

“My dream was to organize pet therapy sessions in prison because it’s the one place where there is a total lack of affection, where dogs can create calm, good moods, emotional bonds and physical contact.”

The program has been a hit with inmates, who look forward to the dogs’ visits and have formed a sense of close companionship with them. When asked who his favourite dog was, one of the inmates said:

“Carmela arrived and didn’t know what to do. She was so scared, sort of like us when we arrive in prison. Now, like us, she too is getting used to the experience.” 

Whether part of psychotherapy, physiotherapy, or a prison inmate program, animal assisted therapy can give people the extra motivation needed to get through the challenge of treatment or confinement. Patients and clinicians alike have a lot to gain from therapists like Rambo.

– Essi Numminen, 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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Mental Health Initiatives for Athletes Still Lacking

00Depression, Featured news, Health, Media, Sport and Competition, Teamwork, Therapy May, 16

Source: Charis Tsevis on Flickr

Canadian NHL teams’—including the Toronto Maple Leafs—third annual Hockey Talks was a month-long initiative to discuss mental health issues and treatment. Athletes and mental health professionals gathered to discuss the stigma and stereotypes associated with mental illness and disability.

One stereotype pertains to professional athletes themselves. The suicide of Toronto-born OHL player Terry Trafford and the suicides of other players in the NHL, as well as retired NHL goaltender Clint Malaschuk’s recovery after his battle with depression, posttraumatic stress disorder, and alcoholism, show that even professional athletes are not immune to mental illness.

Research by Lynette Hughes and Gerard Leavey at the Northern Ireland Association of Mental Health in Belfast, Northern Ireland, shows that athletes may be more vulnerable to developing mental illness than the general population. Results from their studies show that increased risk stems from pressure to perform, and from the variability in healthcare and diagnostic standards between sports psychologists, who are routinely employed by professional sports federations to work with players. But sports psychologists often target only those issues that will improve athletic performance, not overall mental health.

Alan Goldberg, a sport psychology consultant for the University of Connecticut (UConn), says that athletes often work with professionals to overcome problems on the field. Based on his work with the Huskies Hockey program at UConn, Goldberg thinks that players often have trouble communicating with teammates, controlling their temper, or motivating themselves to exercise. They can become anxious or lose focus during competitions, which may lead them to choke at key times.

Big teams can fall prey to these issues as well. The Toronto Maple Leafs’ former coach, Ron Wilson, accused hockey-forward Phil Kessel of being emotionally and physically inconsistent, crippling his performance and hurting his relationships with teammates.

According to Goldberg, sport psychologists focus on helping players enhance performance, cope with pressures of competition, recover from injuries, and keep up exercise routines. But players are more than the sport that they play.

Media scrutiny of players’ behavior, strain on personal relationships from frequent travel, public criticism of their performance, and intensive training regimes can all take a toll on physical and mental health. The problem is, these issues are rarely addressed by sports psychologists.

Treating depression, anxiety, and substance abuse, which are the most common mental illnesses among hockey players, is not in the job description of sport psychologists or exercise professionals hired to work with athletes. Instead, the focus of both athletes and support staff, is on winning. According to Goldberg:

“The overall goal of the sport psychology professional is to enhance the player’s game on the ice. To make them a better teammate and a better performer who can win games and championships.”

And the work schedules of professional athletes—including travel and time away from home—make it hard for them to seek out psychotherapy with psychologists outside the team. As a result, they are left with no access to care.

The mental health programs that do exist, such as the NHL’s Substance Abuse and Behavioural Health Program which help players cope with the use of performance-enhancing drugs, still focus more on the sport than on athletes’ lives. Yet newer initiatives like Hockey Talks have shown more promise.

Giving fans, players, and coaches a chance to voice their thoughts on all forms of mental illness and remove the stigma of professional athletes experiencing mental health problems can be exactly the push professional sports associations need to start providing athletes with the care they require.

Only by realizing that athletes have lives and cares outside of their professional sports can we begin to address mental health needs holistically.

– 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

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RUSH Prevention Program Helping Children of Bipolar Parents

00Bipolar Disorder, Emotion Regulation, Environment, Featured news, Health, Parenting, Stress, Therapy May, 16

Source: Rolands Lakis on Flickr

“It was just kind of not knowing what you were going to get every time. Emotionally when I was younger, I always cared about her. She was my mom. As I grew up, I kind of became disconnected because I didn’t know the real her. I only knew her from her diagnosis. I only knew her emotions. I didn’t know the real her.”

– Steven, child of a bipolar mother.

In 2004, the World Health Organization named Bipolar Disorder (BD) the seventh-leading cause of ‘disease burden’ for women between 15 and 44, a measure that combines years of life lost to early death and years lost to living in subpar health. Public Health Agency of Canada reports that BD occurs in one percent of Canadians, and their reported mortality rates are two to three times greater than the general population.

The disorder is marked by alternating periods of manic euphoria and intense depression. In a manic state, people experience elevated moods, racing thoughts, and sleeplessness, in addition to overspending and engaging in risky sex. The depressive phases make for overwhelming feelings of sadness, withdrawal, and thoughts of death and suicide.

Research has related BD to aggressive behaviour, substance abuse, hypersexuality, and suicide. But more recently, studies have been showing the kinds of challenges faced by children of those diagnosed with the disorder.

The Pittsburgh Bipolar Offspring Study reports that children of bipolar parents are 14 times more likely to develop bipolar spectrum disorder. Children of two bipolar parents are at an even higher risk.

And these children are also more vulnerable to psychosocial problems. A study by Mark Ellenbogen at Concordia University finds them at greater risk for problems with emotional regulation and behavioral control.

Ellenbogen and colleagues have explained how stressful home environments can alter biology to influence mood disorders in adolescents and adults.

In an interview with the Trauma and Mental Health Report, Ellenbogen stated that OBD individuals (that is, offspring of parents with bipolar disorder) show higher levels of daytime cortisol, a hormone that is released during times of stress. OBD are psychologically more sensitive to stresses in their natural environments.

“We have found that high cortisol levels in offspring may represent a biomarker of risk for affective disorders, particularly in vulnerable populations like the OBD. We believe that these changes in cortisol levels can be linked to stress, inconsistent parenting practices and disorganization in the family environment.”

Reducing the stressors in early childhood may help decrease elevated levels of cortisol, and ward off the development of BD and other problems.

Recognizing the need for early intervention, Ellenbogen initiated a pilot prevention program, Reducing Unwanted Stress in the Home (RUSH), which targets bipolar parents and their vulnerable children between six and eleven.

An assessment measures salivary cortisol, looks at the family environment, and evaluates the child’s behaviour. Then parents and children participate in weekly sessions.

With parents, the focus is on improving communication and problem-solving skills, and increasing structure and consistency in the home. With children, they teach skills for understanding and coping with stress through age–appropriate exercises and educational games.

“The goal of the RUSH program is to prevent the development of affective disorders and other mental disorders by intervening in families well before these serious mental disorders begin. That is, this is a prevention program for children at high risk of developing debilitating mental disorders.”

To date, children and parents have been responding well, but the research is ongoing.

Programs like RUSH aim to prevent the development of mental illness in vulnerable youth. And an ounce of prevention can mean a whole lot to quality of life down the road.

– 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

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When Adolescents Claim the Right to Refuse Treatment

00Child Development, Decision-Making, Family Dynamics, Featured news, Parenting, Therapy April, 16

Source: UnitedNotions Film, Used with permission

In a personal essay in the Hartford Courant, 17-year old Cassandra C. recalls her legal battle when she refused to undergo chemotherapy after being diagnosed with Hodgkin Lymphoma, a cancer of the lymphatic system.

The Connecticut Superior Court ruled that as a minor, Cassandra did not understand the severity of her condition. She was taken to Connecticut Children’s Medical Center in Hartford, where she was forced to undergo chemotherapy.

In her essay, Cassandra wrote:

“I should have had the right to say no, but I didn’t. I was strapped to a bed by my wrists and ankles and sedated. I woke up in the recovery room with a port surgically placed in my chest. I was outraged and felt completely violated.”

When Cassandra’s mother did not bring her to medical appointments, the Department of Children and Families took Cassandra into custody. She was medically examined and placed into foster care.

A month later, Cassandra was allowed to return home once she agreed to continue chemotherapy. After reluctantly undergoing two days of treatment, Cassandra claimed that it was beginning to take a toll. Feeling trapped, she decided to run away to evade treatment, only returning home out of fear her disappearance would land her mother in jail.

It is common for cancer patients to experience adverse side effects while undergoing chemotherapy. In addition to physical side effects, patients often experience a range of psychopathologies, including depression, fear, anxiety, and hopelessness.

In court, Cassandra argued that she cared more about the quality of her life than the duration. Yet she was told that undergoing chemotherapy would increase her chance of survival by 85 percent. Without it, doctors said there would be a near certainty of death within two years. Although Cassandra acknowledged this risk, she maintained that she had the right to make decisions about her own life and body.

In an interview with the New York Times, Cassandra’s mother supported her daughter’s decision to refuse chemotherapy:

“She knows the long-term effects of having chemo, what it does to your organs, what it does to your body. She may not be able to have children after this because it affects everything in your body, it not only kills cancer, it kills everything in your body.”

Both Cassandra and her mother denied that Cassandra’s decision was anyone’s but her own. But there is some concern that Cassandra’s opinion on medical treatment could have been influenced by her parents. This issue is especially important given the far greater chance of survival offered by treatment.

A study by psychiatrist Paola Carbone in the Journal of Child Psychotherapy describes how young cancer patients may have trouble accepting treatment because of its severe effects on their developing bodies. Adolescent girls often express dissatisfaction with their bodies and lower self-esteem. The side effects of chemotherapy, such as weight loss, may negatively affect their fragile self-confidence.

The right to independent decision-making at this age is also a factor. In her essay, Cassandra writes:

“I am a human—I should be able to decide if I do or don’t want chemotherapy, whether I live 17 years or 100 years should not be anyone’s choice but mine.”

Researchers, Coralie Wilson and Frank Deane, suggest that it is important to teach adolescents’ that part of being more independent and autonomous is being aware of when and how to seek the support of others.

An extreme need for independence can result in self-imposed isolation, which is why Carbone maintains that adolescents are particularly in need of familial support. Other studies have also found that family involvement in discussions about the side effects of chemotherapy improves social support and decision making, lowers physical and mental distress, and increases emotional wellbeing.

Carbone explains:

“Chemotherapy refusal by adolescent patients should not be considered an obstacle to be eliminated at all costs, but rather a message to be welcomed and worked on.”

Cassandra was discharged from hospital last April, after completing treatment. Prior to being released, she wrote on Facebook, “I have less than 48 hours left in this hospital and I couldn’t be happier!”

She reported that she was grateful that she responded positively to the drugs and was predicted to survive cancer-free. But she also added:

“I stood up and fought for my rights, and I don’t regret it.”

– 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

2 Documentary film tells story of race...-3b7dfcbb54e73e70fecec5726453d2f901a6fd3f

Documentary Film Tells Story of Race, Drugs and Baseball

00Addiction, Featured news, Personality, Psychopharmacology, Race and Ethnicity, Resilience, Therapy April, 16

Source: baseball971 on Flickr

Narratives surrounding professional sport often make stories about performance-enhancing drugs as common a spectacle as the sports themselves. As the story often goes, pressure to succeed and maintain peak physical form drives many professional athletes to substance abuse.

We hear this tale again in Jeffrey Radice’s biographical film, “No No: A Dockumentary,” titled as a play on the name of the story’s subject, Dock Ellis, a black Major League Baseball (MLB) pitcher famous for using drugs while on the mound. In the film, Radice examines Ellis’ struggle with drug abuse, digging deep into his life story and the environment in which he played.

Beginning his major league career in the late 1960s with the Pittsburgh Pirates, Ellis was no stranger to the racial stigmatization faced by many black Americans during this time. Through interviews with former teammates, family members, and childhood friends, Radice shows the pride Ellis had for his culture’s acceptance into MLB. In his time as a professional athlete, he became known for his strong verbosity – he was expressive, opinionated, and willing to disobey MLB rules.

He also established himself as an elite pitcher in the league. His success did not come easily or without a price. Of this experience, Ellis says:

“When you get to the major leagues, it’s easier coming up the ladder, but it’s hell to stay there.”

Ellis’ initial drug of choice was a stimulant called “dexamyl,” popularly known as “greenies” in the MLB. This type of drug is classified as an amphetamine; side effects include alertness, a decreased sense of fatigue, mood elevation, and increased self-confidence. According to Ellis, “greenies” made him feel sharper and allowed him to throw with pinpoint accuracy.

On the eve of June 12th, 1970, Ellis took LSD, a hallucinogen, which lead to his most memorable performance: throwing a perfect game.

In the first half of the documentary, Ellis’ life is described as erratic but exciting, colourful, and Hollywood-like. Radice depicts Ellis’ drug-abuse in a surprisingly lighthearted manner. Ellis chuckles as he reminisces about his high-flying lifestyle when he was at the top of his game. He is portrayed as a baseball superstar, his drug abuse merely a stepping-stone to his success.

In the second half of his film however, Radice shifts his perspective to view the film’s subject through the lens of mental health. While portraying Ellis as good at what he did, Radice asks whether his success in the MLB justified his drug and alcohol abuse.

At one point, Ellis is shown coming off drugs and tearfully admitting his dependence on them. After his retirement and an unfortunate drug-fueled spousal assault, he entered rehab and spent the rest of his life mentoring and counseling other drug-dependent individuals. He stayed sober up until his death in 2008.

The juxtaposition in the documentary – between an outlandish and erratic drug-using icon and a recovered, empathic individual – is moving and effective. It represents the highs and the lows drug users face when coming to terms with their addiction, and the fight to stay sober and live a more fulfilling life.

Toward the end of the film, Ellis reads a letter sent to him by Jackie Robinson, the first African American to play in the MLB:

“There will be times when you will ask yourself if it’s worth it all. I can only say, ‘Dock, it is’ and even though you will want to yield, in the long run your own feeling about yourself will be most important. Try not to be left alone.”

Although Robinson is referring to Ellis’ determination to gain equality in the MLB, his words also relate to the issue of drug-use and addiction in professional sports. The way “No No: A Dockumentary” approaches Ellis’ biography is unique: it idolizes a great baseball player, but also highlights his dark side and shows what Ellis ultimately lost because of drug dependence.

– Alessandro Perri, 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