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When a subway passenger dies by suicide, workers suffer too

00Featured news, Health, Post-Traumatic Stress Disorder, Suicide, Trauma, Work August, 19

Source: Lily Banse at Unsplash, Creative Commons

In an article in a Canadian daily, The Globe and Mail, Oliver Moore reported that during 2016, 21 suicide attempts occurred on Toronto’s subway system. In fact, a study published by the Journal of Urban Health considers suicide on subway platforms to be a public health issue.

Subway delays by attempted suicide not only affect passengers, the victims and their families, but drivers as well. Subway workers and drivers who have witnessed a suicide have been reported to have Post-Traumatic Stress Disorder (PTSD). Research suggests that those exposed to human-generated traumatic events have a greater chance of developing PTSD.   In an interview with Vice Magazine, psychologist Wilfried Echterhoff discussed the long-lasting psychological trauma workers face when confronted with a death on the worksite:

“Some people have never been confronted with death before…To suddenly be confronted with it in such a violent way can lead to PTSD or a serious depression.”

In an interview with the Trauma and Mental Health Report, Robert (name changed), a retired subway worker with over 30 years of experience, described an incident he faced while working: 

“One Saturday afternoon maybe around 11:00 a.m. or 12:00 p.m., I witnessed a lady jump off the subway platform. I needed to go upstairs and tell my supervisor and my supervisor told me that my face was all white. They kicked everyone out and only the police and ambulance were allowed to come in.” 

Nik Douglas, a train driver who worked for the Northallerton subway station in the UK, noted in an interview with The Independent:   

“When I was on my own I’d burst into tears for no reason, I found sleep hard and I’d have flashbacks during the night and day. I could be in a room full of people with a really good party atmosphere but feel alone and isolated. That’s one of the biggest things I remember, feeling alone… It changed my life instantly from who I was to what I have become. Some people aren’t affected, but two years after it happened I’m still not the same person.”

In deciding what was best for his mental health, Nik took six months off work to deal with his PTSD. Recent studies suggest that in Canada, 6.5% of subway workers have been absent from work due to witnessing suicides while working. Last November, this rate was at its highest with 7.44% of employees absent. Some employees are unable to return to work altogether and opt to receive compensation from their employers.

Nik experienced intrusive distress and feelings of isolation. Kevin, a 39-year-old subway driver expressed his feeling of being responsible for the suicide of a man:

“When he looked at me and our eyes met, time just stood still. It felt like driving your car over railroad tracks, that rumbling feeling you get … I realized then that I just killed somebody.”  

In his years of working at the subway, Robert explained the brief protocol subway workers go through once they have witnessed a suicide:

“The subway drivers have to talk to the police after that happens. They always have to stay and give a statement. Then they’re taken off duty for that day. Then they get sent home or to counselling. It depends on what the driver wants to do. It just started recently in the last five or six years.  The company asks if the drivers want to speak to someone.”

Effective suicide preventions have been created to decrease the suicide rate in subway stations and increase safety. Subway stations in Tokyo have implemented glass doors that open for passengers to board the subway only once it has arrived in the station. Other preventions put in place are blue lights and mirrors set up to discourage suicide attempts. In London and Paris, these forms of preventions have been effective too. 

In addition, intervention programs, including the Gatekeeper Program, exist for those who are feeling suicidal.  However, interventions put in place for subway workers who experience suicides are rare. Most workers deal with the effect of these experiences on their own. In Robert’s words:

“If something is going to happen, it’s going to happen.  There’s nothing you can do. They don’t tell you this can happen or that can happen.  They won’t tell you what can happen when you sign up for this job.  They don’t tell you that workers deal with this.  They don’t train you how to deal with it.  They won’t ever tell you what to expect even when training people.”

Social support is argued to be one of the most powerful factors in recovering from PTSD and is known to decrease risk for depression, foster resilience, and reduce stress in those who have experienced traumatic events.  Mindfulness-based stress reduction therapy has shown to reduce stress and increase recovery in those with PTSD.  

Lucia Chiara Limanni, 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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Universities Can Do Better To Help with Mental Illness

00Anxiety, Attention, Emotion Regulation, Featured news, Social Life, Stress August, 19

Source: Filip Bunkens at Unsplash

A good friend of mine, Jessica (name changed), was diagnosed with social anxiety disorder in September of 2017, the same year she enrolled in university. And, as is the case with many other mental illnesses, her anxiety took over her life.  

Post-secondary students all over the world face mental illnesses that affect their schooling.  Research done at the University of Alberta suggests that half of the student population felt “overwhelming anxiety” within the past 12 months of attending university. In an interview with the Trauma and Mental Health Report, Jessica shares her experience dealing with anxiety at school as a “feeling of constant worrying that goes away only when she leaves class”.  

After taking some time to review her current situation, Jessica dropped out of school. Psychologist Martin Antony, professor at Ryerson University in Toronto, and author of the Shyness and Social Anxiety Workbook discussed the impairment those with anxiety-related disorders can experience:  

  “It is not uncommon for people with especially high levels of anxiety to drop out of school completely or take a leave of absence from school.”

Despite this fact, there has been little research on the relationship between anxiety and quitting school. One study found that out of 201 individuals with anxiety disorders, 49% dropped out of school, with 24% of dropouts attributing their decision to their anxiety. These students often struggle with going back to school and completing their degrees. The main hindrance Jessica faces is the delay in receiving her degree:

“The art program has specialized studio classes where they teach pottery, photography, sculpting, painting, stone carving, things like that. I don’t know how long it’s going to delay my schooling.”

Without being physically present in these classes, Jessica fails to complete her degree requirements.  Inevitably, this puts her behind in finishing her typical four-year degree.

The Anxiety and Depression Association of America suggests that accommodations can help alleviate anxiety experience at school. In the U.S., students have the right under the Individuals with Disabilities Education Act (IDEA) to request accommodations such as writing in alternative exam rooms, or receiving longer time for exams.  

However, these accommodations are quite general, and may do more harm than good. Clinical psychologist, Anu Asnaani, at the Center for the Treatment and Study of Anxiety and assistant professor at the University of Pennsylvania explains the importance of meeting the needs of each student. As anxiety and depression based disorders require specialty interventions, Asnaani believes that school administered accommodations will not treat them.

Similarly, Martin Antony agrees that accommodations recommended by schools may help maintain anxiety rather than help students overcome it:

“One of the most powerful ways of overcoming a fear of being around others is to practice being around others. However, accommodations may run counter to this idea by isolating students. Accommodations such as these may help people to feel more comfortable in the short term, but they may also interfere with overcoming fear in the long term.”

Jessica recalls her experience with the counselling and disability service at her university as unhelpful. She received accommodations of lecture notes, a seat with an empty chair on each side of her, the ability to sit close to the back of the room, and alternative exam testing. Yet, none of these accommodations helped reduce her anxiety.

Regarding counselling, disability, and student wellness centers across all post-secondary institutions, Asnaani recommends: 

“If the techniques and therapy that the counselling centers at school administer are not working for the students, then being able to make a referral to community partners is important.  Other resources that students can look at for help or finding a suitable therapist are the Association for Behavioral and Cognitive Therapies and Anxiety and Depression Association of America.” 

Inevitably, Jessica enrolled in online classes to slowly continue working towards the completion of her degree. However, this isn’t always a solution, especially for individuals in hands-on programs, such as art. For Jessica, the online classes helped eliminate her anxiety.  She is now able to work on her course work in the comfort of her own home. 

Anxiety therapies often teach their patients how to be their own therapist. When asked about mechanisms students learn in therapy, Asnaani and Antony agree that exposing yourself to the feared situation over time and cognitive-behavioural therapies can help reduce anxiety in students.  

For Jessica, the experience has been life changing.  She often wishes that she had received more support from her school and offers this piece of advice to others in similar situations:

“Take things step by step, you and your well-being are the most important. It’s okay to take time for yourself and there is no rush to finish school. There are other routes to take if you are unable to attend classes, such as taking online classes like I’ve been doing. You are not alone in this situation and there are always people to talk to and resources available to you, whether at the school or even online.”

Fortunately, for Jessica, online classes enabled her to complete some of her first-year elective courses. Unfortunately, there is still a lack of adequate tailored accommodations for post-secondary students experiencing mental disorders preventing them from gaining the education they need for their future careers.

– Lucia Chiara Limanni, 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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After Children Are Freed From Captivity

00Caregiving, Cognition, Depression, Embarrassment, Featured news, Law and Crime, Shyness, Trauma July, 19

Source: James Sutton, creative commons

On occasion, we hear of extreme cases of child abuse, making family names like the Turpins infamous.

The 13 Turpin children were held captive in their house, where they were limited to only one meal a day and one shower a year. Twelve of the children were subject to extreme physical abuse, and one suffered from sexual abuse. The eldest child, who was 29 years old, weighed only 82 pounds.

Cases like these often publicize legal proceedings and atrocities committed by the parents, but disregard what happens to these children—the victims— in the aftermath. 

Research on children held captive is sparse, however, there are some studies of other high-profile cases where children suffered extreme deprivation. A well-known one is Genie, a child who was isolated in a small bedroom where she was strapped to a toilet seat during the day, or trapped in a crib with wire covering. She received absolutely no stimulation and was only fed infant food. 

When Genie was found at age 13, she was unable to perform basic functions, such as chewing, biting, standing or walking. She spent years trying to learn to speak, but was unable to acquire language fully or normally. After years of testing by psychologists and physicians, her mother forbade further assessment of Genie, and she is now living in the care of the state of California.

Maude Julien, a psychotherapist from France who herself was subjected to captivity by her parents, now treats patients who are victims of trauma. In an interview with The Trauma and Mental Health Report, Maude describes her experiences growing up.

“For about 15 years, I practically never went out. I never went to school; my mother was my home-school teacher. My father wanted to create a superhuman, uncorrupted by this world,” Maude said. “I had to undergo a ‘training of the mind’ in order to become this ‘superhuman.’ He wanted me to believe that the world outside was terrible.”

Maude described the effects severe trauma caused and explained her recovery process.

“I had to learn the simplest, most basic social conventions like speaking to strangers or finding my way around. Above all, I had to learn how to talk, because my long periods of forced silence had made me almost mute,” Maude said.

“Even though I was learning all this, I was still imprisoned behind the ‘gates’ of conditioning. I could still hear in my head, day and night, the tick-tock of my father timing everything,” she said.

Maude described her recovery as the need to “free herself from the mental and emotional hold” she was under. It took her more than 10 years to overcome the consequences of her imprisonment.

Maude explains how reading, and connecting with animals and other people helped her cope with trauma. She attributes her ability to get out of the house to her music teacher and describes her second husband’s parents as an instrumental part in helping her mature.

“I was 24 when I met them and they helped the child inside me grow up. I felt unconditional parental love for the first time; it’s one of the greatest gifts in the world,” Maude said.

Children who have been held captive by a relative often think they deserve it, and live with a heavy feeling of shame and guilt. 

“It’s usually shame that prevents victims from seeking help,” Maude said. “They have also a feeling of isolation, because a predator like my father, makes the victim believe that he alone can love and protect them.”

Children reported in these high-profile cases may feel guilty for having “betrayed” their parents, yet may also feel relief for having escaped. She describes living with this duality as being very “painful.”

“They will have to free themselves from the ‘psychological leash’ imposed by their predator,” Maude said. “They will have to learn how to trust certain people, and they will have to learn how to recognize other predators and stay away from them. Most of all, they have to learn how to trust themselves.”

—Amanda Piccirilli, 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 Bipolar Disorder Brings Marital Distress

00Bipolar Disorder, Depression, Featured news, Marriage, Stress, Suicide July, 19

Source: Cristina Jiménez Ledesma at Flickr, some rights reserved

In a busy urban community church, Reverend John Tahir, a parish minister, enjoys many moments helping and advising members of his congregation. One of his more meaningful responsibilities is counselling young couples, providing marriage education to them with the hopes of preparing them for this new chapter in their lives. The importance of this task is not lost on Tahir, as he knows far too well that significant issues such as money, boundaries, and lack of communication to name a few, can result in marital challenges. The reality is that marriage can be a rather difficult journey. 

Dr. Gary Chapman’s book, The Five Love Languages, examines marital discord resulting from a lack of effective communication. The premise is that every person enters a marriage with their own definition of what love means. As a result of these inevitable differences, people have distinctive love languages. According to Chapman, problems in marriage arise primarily because people often expect their spouse to demonstrate love in a way that is compatible with their own love language.  

It is not hard to imagine that living with a spouse struggling with a mental health disorder only adds to the complexities of marriage. The divorce rate varies among mental health disabilities because each condition presents its own unique challenges. For example, those who have phobias and obsessive compulsive disorders have a much lower divorce rate than affective disorders such as bipolar disorder and depression. Though there are four different types, bipolar disorder is characterized by drastic mood shifts with either manic or depressive episodes. Those with this affective disorder can experience high, elated, and energized moods while experiencing hopeless and depressive ones at other times. It is interesting to note that the divorce rate of those with bipolar disorder is very high—approximately double the rate of the general population.

In an interview with the Trauma and Mental Health Report, Brian (name changed for anonymity) shares his experience of having bipolar disorder: 

“It’s been hell struggling with suicidal thoughts every day. I’ve lost a sense of joy and optimism.  I find it difficult to complete even regular daily activities.”

Brian’s struggles have taken a great toll on Christina, his wife. Spouses of individuals with bipolar disorder, like Christina, may be at increased risk of stigma, stress, depression, psychiatric symptoms and a decreased quality of life:

“My life revolves around my husband. I’ve taken on a lot of additional responsibilities and it has affected my physical and mental wellbeing.” 

Christina recalls being late for a recent meeting because she was afraid that her husband was going to kill himself: 

“I didn’t feel comfortable leaving him at home that day. I had my mother-in-law come over so that I could attend my meeting.”

The relational interaction between spouses, where one is a patient and the other a caregiver, can contribute to additional marital challenges. Research suggests that neither patients with bipolar disorder, nor their spouses were accurate in describing each other’s experiences and concerns when it came to the impact of the disorder on their lives. These differing perspectives can lead to marital difficulties because each partner’s thoughts and feelings are misunderstood and challenged. The issue speaks to a lack of effective communication, which Chapman believes can contribute to the breakdown of the relationship.  

Brian and Christina both emphasized certain themes that were important to themselves while neglecting other aspects that were important to the other. When asked to reflect on a specific experience related to Brian’s psychiatric treatment, the couple highlights different concerns:

Christina: “I feel frustrated and helpless due to the lack of support and guidance from medical professionals. I have to constantly fight for Brian to receive proper treatment.”

Brian: “I have first-hand experience as a patient. When I’m in the hospital, I feel like I lose my identity as an individual. I am treated as just one among many other patients with a mental illness.”   

Lack of effective communication appears to be a common theme in all marital problems, which becomes further impaired when coping with the difficult challenges associated with bipolar disorder.  

In his book, Chapman asks:

“Could it be that deep inside hurting couples exists an invisible ‘emotional love tank’ with its gauge on empty?…If we could find a way to fill it, could the marriage be reborn? With a full tank, would couples be able to create an emotional climate where it is possible to discuss differences and resolve conflicts? Could that tank be the key that makes marriage work?

—Young Cho, 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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Caring for a Loved One with Alzheimer’s Brings Benefits

00Aging, Burnout, Caregiving, Featured news, Health, Memory June, 19

Source: Edwin & Kelly Tofslie at Flickr, Creative Commons

“I’m always in the present. I have to be one step ahead of David. Things go missing all the time in this house—the remote, mail and even the utensils. I’m down to a handful of forks! It would be simple if I could just lock the door to store some important items, but he doesn’t like that.”

Mary (name changed for anonymity) is the primary caregiver for David, her husband of 50 years who is in the final stages of Alzheimer’s disease. For Mary, ‘being in the present’ refers to her constant worry about even the most mundane elements of life that many take for granted. 

Recent estimates show that over 5 million Americans are living with Alzheimer’s—a number expected to rise to as high as 16 million by 2050. Currently more than 15 million Americans function as primary caregivers and provide essential, albeit unpaid care for people with Alzheimer’s and other dementia-related illnesses, taking on responsibilities such as bathing, grooming, dressing, feeding, and providing additional daily living assistance. At times, caregivers may even have to manage unexpected and unprovoked acts of violence, paranoia, and inappropriate sexual behaviours.  Mary understands this reality all too well. In an interview with the Trauma and Mental Health Report she confirms this additional stress:

“I take David everywhere I go. I’m always scared that he will do something unpredictable, embarrassing and grossly inappropriate.”

This demanding and overwhelming role can take an emotional toll, putting caregivers at risk of becoming socially isolated, exhausted, and suffering from burnout. It is clear that there are drawbacks to being a primary caregiver and Mary has experienced many of them, such as loneliness, guilt, embarrassment, frustration, and even verbal and physical abuse. Mary and many individuals in similar circumstances, continue to do so at the expense of their own wellbeing.

But a growing body of research shows that despite challenges, there are positive aspects associated with providing such care for another person. Studies report that some experience an enhanced sense of meaning in their lives, while others feel a sense of empowerment as they learn how to navigate the health and social systems related to the illness. Caregivers have also been found to frequently reminisce on happy memories, enjoy pleasurable activities, and develop a deeper appreciation for time spent with their loved ones.

When reflecting on their life and their current situation, many of the positive benefits of caregiving resonate with Mary:

“Throughout our marriage, we lived separate lives. At times, I resented David because he would often leave me to go play golf.  I felt a distance between us. Now our situation has forced me to spend time with him and in some ways, I’m getting what I longed for. I’ve become closer to family members who have assisted me with David’s care for which I am so grateful. You truly learn who is there for you.”

In addition to gaining a deeper appreciation for her family, Mary acknowledges that she has also grown substantially as an individual:

“I have become more patient and have learned to effectively de-escalate situations. I am confident I can handle a lot more than I could before.”

Speaking with her, it is evident that Mary has come to appreciate the little things in life:

“Despite our daily struggles, there are precious moments; moments when I see glimpses into his soul. Some days when I pick him up from the nursing home, he is eagerly waiting for me by the window. I’m sure he thinks that I’m solely his caregiver. But, I can see his vulnerability and I know that he needs me.”

Many factors appear to influence caregiver resilience: the intensity and context of the provided care, socio-demographics such as age, gender, education, the availability of social and community resources, and the caregiver’s psychological attributes. Though Mary fully acknowledges the struggles and stresses that come with her role caring for David, she remains resilient. And no matter how difficult her situation may get, she stays focused on the gifts this experience has brought her. 

-Young Cho, 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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Coping Through the Lens of a Camera

00Attention, Career, Ethics and Morality, Featured news, Media, Trauma, Work May, 19

Source: American Documentary, Inc at Flickr, Creative Commons

Documentaries tell compelling stories. But while we become captivated by moments on screen, we forget there is someone behind the camera, watching events unfold in real-time. Cameraperson, a recently released documentary by Kirsten Johnson, portrays her experiences filming documentaries, and it includes footage captured while traveling and filming.

Johnson has travelled the world – from the United States, to South America, to Europe – filming documentaries on topics such as America’s hunger problem or a notorious FBI burglary. She worked on Citizen Four, a documentary about a former CIA agent leaking government information. Sometimes, the stories are about traumatic historical events such as the Rwandan Genocide and the Bosnian War. She has visited the sites of mass killings and heard the stories of people who have survived tragedies. 

I had the opportunity to speak with Johnson, and learn about her experiences. Born in Seattle, she was always curious about the world and wanted to travel. She describes herself as a “visual person.” And as the daughter of a psychiatrist, she always wondered about the unique experiences of others. Her personal background, along with an interest in political inequalities, led her to pursue a career in documentary filmmaking.

In an interview with the Trauma and Mental Health Report, Johnson explains why she followed this path:

“As a doc filmmaker you’re trying to help reveal a human rights injustice, or a problem that people haven’t looked at or paid attention to, and you know people don’t want to hear it. People don’t want to watch a film about rape in Bosnia. Then the question is, how do you find a way for people to look at things they don’t want to look at?”

I asked Johnson about one of her first jobs filming documentaries:

“I filmed over 200 interviews with holocaust survivors, it was one of the first experiences I had in filmmaking and being deeply interested in how people tell the stories of their trauma. I got interested in the stories themselves, and how people remember them because some people remember different aspects. What I found surprising was that over half the people I interviewed had never talked to anyone about it before—this was the first time they had ever talked about it. There was just a curiosity in me, how could it be that somebody experienced something so devastating and never spoke of it?”

Many filmmakers have likely had similar experiences, so I was curious if Johnson had ever shared her experiences with other people in the industry:

“As camera people, we work so much we rarely get the chance to talk together. I have always talked a great deal with the people who I film with as they’re listening and I’m watching. We process our experience together. Or the translators, those are the kinds of people I’ve had deep conversations about things we were witnessing together.”

Johnson described some of the unspeakable events she had witnessed, and how she copes with the trauma while still doing her work:

“There’s often an aesthetic pleasure even though you may be filming a terrible moment—somehow, the light, the fabric, their skin, what they are wearing, helps you as the camera person cope with the things you are taking in. That’s what I realized when I was looking back at my own footage. It’s this active creative process you’re involved with when you’re trying to organize it and see it differently and search for the beauty in it.”

She described one such experience with a Bosnian family:

“We were filming about how rape was a weapon during the Bosnian war and listening to horrible stories about people who had to leave their homes. Being with one of the few families who had returned to their home—it was beautiful to witness that.”

When asked about the particularly overwhelming and painful moments she is confronted with during film shoots, Johnson incorporates practical and simple strategies to maintain “psychological equilibrium”. 

“ I try to sleep enough, eat with relish, laugh a lot and move in all kinds of ways. I read what others have written, talk to friends, see a therapist who has known me for years, watch movies and play with my kids. If I have been traveling too much, I stay home and if I have stayed somewhere too long, I go somewhere new and the world surprises me one more time.” 

The importance of telling stories is integral to documentaries. Filmmaking is about more than just reporting on tragedies, it’s about giving people a voice. Yet, more often than not, we don’t think about the person behind the camera, who witnesses trauma in order to share stories with the world.

-Amanda Piccirelli, 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 Doctors Are At-Risk for Suicide

00Burnout, Depression, Embarrassment, Emotion Regulation, Featured news, Health, Suicide May, 19

Source: Feature: skeeze at Pixabay, Creative Commons

They had known each other well enough in the early days of medical school, when they were students studying well into the night. After graduation, they went their separate ways, each assuming the other was doing well.

“I wanted you to hear it from me,” a colleague sadly said on the phone. Dr. Ranjana Srivastava nearly fell to the pavement when she was told that her long-time friend and colleague—a clinician, wife, and devoted mother—had died by suicide.

Unfortunately, this is not the first that time Dr. Srivastava had to face the suicide of a colleague. In a piece she wrote for The Guardian, Srivastava explains:

“Forced smiles and tough hides abound in the workplace, where always being ‘fine’ is a badge of honour. This is why it can be so difficult to distinguish doctors who will indeed be fine from those who need help.”

Research shows a higher rate of mental health problems among physicians. A 2013 report estimates over 25% of doctors in Australia having at least a minor psychiatric disorder, with 10% reporting suicidal thoughts in the past year. A survey of 2000 U.S. physicians showed that roughly half believed they met criteria for a mental illness in the past, but had not sought treatment. And in Canada, recent research estimates over 26% of Canadian doctors suffer professionally due to poor mental health, with 20% of them reporting they had been depressed in the last 12 months. Overall, roughly 30% of physicians worldwide have depression or symptoms of it, according to an extensive review published in the Journal of the American Medical Association (JAMA).

Why is this the case? The answer isn’t all that clear, but according to physician and social worker Katharine Gold and colleagues, stigma is to blame. Their research looked at survey responses of over 2000 female physicians, and it showed that stigma attached to mental illness is greater among medical trainees and physicians than in the general population. According to one respondent:

“I have been discriminated against in a department after disclosing my history of well-treated depression to my department chief.”

And this is not an isolated incident. Studies show that 50% of doctors are less likely to work with a colleague who has a history of depression or anxiety disorder, with four in ten admitting to thinking less of such a colleague. And throughout the years, healthcare organizations have favoured a punitive approach when addressing the issue of physician mental illness, rather than a supportive one. So disclosing mental health issues by a medical doctor can pose a real threat to licensing, career, and reputation, leading to reluctance to seek help.

In an interview with the Trauma & Mental Health Report, medical student Jamie Katuna explains the predicament physicians face:

“Getting care could mean problems for doctors. If they seek help for mental health issues and if someone decides they are ‘unstable’ and shouldn’t be seeing patients, that physician is out of a job and would have a really hard time finding another one. So instead, doctors suffer in silence.”

When deteriorating mental health makes it difficult to work, many physicians ignore their symptoms and continue to work anyway, often self-medicating with drugs or alcohol to avoid the perceived embarrassment of having a psychological disorder.

Steps are being taken to bring awareness. Many universities and medical organizations are starting conversations about physician wellness and stigma reduction. Physicians and medical students who have lived through suicide attempts, depression, and other mental health issues are standing up for themselves and each other. Likewise, organizations such as the American Foundation for Suicide Prevention and the American Medical Association have recommended reforming medical licensing questions to make it clear that physicians may get help without fear of negative consequences. Despite the growing support, Thomas Schwenk of the University of Nevada School of Medicine noted that change isn’t happening fast enough:

“A lot of [conversations about mental health stigma are] very difficult and very slow to happen, and unfortunately tragic incidents like the two suicides in Quebec and other suicides across the country are still occurring because it’s taking time to change that culture.”

There are some resources available. In Canada, organizations like Physician Health Program and the Canadian Medical Association provide a range of direct services for physicians and medical students at risk of, or suffering from, substance use, psychiatric disorders, or occupational stress. The interventions offered can include awareness workshops, referral to treatment, and monitoring, all while maintaining confidentiality. Also, online resources such as ePhysicianHealth and Combating Stigma are available.

Most solutions exist at a personal or program level, but the problems are pervasive and affect the entire structure of healthcare education. According to Katuna:

“The culture of medicine should undergo amazing and radical transformations. We need to redesign how we implement medical education.”

Systematic problems require systematic solutions and until then, medical professionals remain at risk.

— Ilia Azari, 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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Misdiagnosis All Too Common for Women with Autism

00ADHD, Autism, Cognition, Featured news, Gender, Health, Wisdom May, 19

Source: Ryan McGuire at Gratisography, Creative Commons

After twenty-eight years of being “dragged through the system,” Emily Swiatek was finally diagnosed with Asperger’s, a branch of Autism Spectrum Disorder (ASD). For Emily, receiving the diagnosis felt like “coming home to a version of yourself that you have been denied of.”

Research shows that Autism Spectrum Disorder is more prevalent in males than females by a ratio of three to one. But there is increasing evidence that this gender difference may be slimmer than we think, and that autism symptoms in women and girls are frequently overlooked and misdiagnosed. 

In an interview with the Trauma and Mental Health Report, Emily explains her frustration with being shuffled from one specialist to another for years, without receiving an adequate explanation for her symptoms: 

“I’ve been through quite a long journey, being given about 10 mental health diagnoses along the way. It was getting to that point where it felt like I was caught in the middle of a guessing game. I kept coming up against the same response of ‘we don’t really understand let’s keep throwing the labels and see what sticks’.” 

The National Autistic Society survey conducted in the United Kingdom found that compared to males, women and girls are more likely to be misdiagnosed, with 42% of females diagnosed with a mental disorder other than autism when being assessed, as opposed to 30% of males. 

Emily’s experience is not unique. Hannah Belcher, who was diagnosed with Asperger’s Syndrome at 23, shares her experience:

“Throughout my life, I’ve been diagnosed with Anxiety, Depression, Bipolar, traits of Borderline Personality Disorder, and ADHD. Some correct and comorbid, some incorrect and misdiagnosed.”

There is no clear explanation as to why women with autism are often misdiagnosed. Child psychiatrist Meng-Chuan Lai, a clinician-scientist at the Centre for Addiction and Mental Health says that while there is a range of different reasons why women receive a diagnosis of ASD later in life, one possibility is that autism characteristics aren’t so evident in females: 

“Girls and women may be more able to master ‘camouflaging’, so ‘typical’ autistic characteristics could be masked when they learn social skills.” 

Lai describes this as the ability to learn neurotypical social behaviours such as eye contact, gestures, holding conversations, and the utilization of social scripts.  These neurotypical behaviours represent those who are not on the autism spectrum in contrast to the neurodiverse behaviours which refer to differently wired brains and cognitive styles attributed to those on the autism spectrum. 

In the foreword for Safety Skills for Asperger Women by Liane Holliday Willey, Tony Atwood describes this “camouflaging” phenomenon, reporting that young girls mask the symptoms of autism by socializing and interacting with their peers, causing a delay in diagnosis.  

Both Hannah and Emily attribute mimicking socialization patterns as an important factor. Emily explains: 

“I’m not a part of that traditional profile of autism… It never even occurred to anyone who was assessing me that somebody who looks like me, somebody who presents like me, could be autistic because I’m smiley, I’m eloquent, I can probably make eye contact if I have to, even though I don’t like it. I’m a very strong mimicker and that masking and mimicking profile is true for me.  I think I very much fit that ‘well behaved little girl’ image—very intelligent, liked reading, very quiet, maybe they’d say I was shy.”  

Lai notes that another possible reason for the misdiagnosis is that women and girls tend to have restricted and repetitive behaviours that are less likely to be recognized:

“The issue is that some of these narrow interests of autism in males, if you only look at the content, are more traditionally male-typical such as trains, dinosaurs, trucks, and they are most easily recognized by clinicians because of our own stereotypes of autism. For girls, their restricted and repetitive behaviours might not be captured by standardized instruments as they are deemed as less noticeable.”

Recent research has touched on the idea of bias in the way autism is diagnosed. One study showed that girls are more likely to be diagnosed if they had an additional intellectual disability or behavioural issues. However, without these, many women are receiving incorrect diagnoses, or none at all. Hannah agrees:

“Sometimes you might feel like you don’t fit in anywhere, everything everyone thinks about autism is male biased. However, as slow and painful as the journey is, there is always a light at the end of the tunnel. It takes us a little bit longer to get to it, but it is worth the journey.

In a study looking at sex differences between children with autism, researchers recommend new strategies for improving autism recognition in females. In fact, Australia is the first country to form new national guidelines to help increase early diagnosis of women with autism.  Considerations of social camouflaging, anxiety, sensory overload, and depression are being included in these new guidelines.  

If these guidelines are implemented, it will be possible to decrease the number of misdiagnoses in women and girls who have autism, leading to less frustration for these women and more time to learn how to manage their diagnosis. Emily says that since she received her diagnosis, her life has changed for the better:

“It was instant relief the minute I got my diagnosis. It just made sense. It was right. It was instantaneous the difference it made. My general well-being just went up and up and up, and is still on an upward trajectory.”    

-Lucia Chiara Limanni, 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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Jurors Are Left Traumatized by Some Court Cases

00Decision-Making, Dopamine, Empathy, Featured news, Health, Law and Crime, Post-Traumatic Stress Disorder, Stress, Trauma April, 19

Source: Marica Villeneuve, Trauma and Mental Health Report artist, used with permission

On November 7, 2016, the Ministry of the Attorney General of Ontario reached a settlement with a juror diagnosed with vicarious post-traumatic stress disorder. The juror served on the trial of eight-year-old Tori Stafford’s killer.

The woman, who cannot be named due to a publication ban protecting the identity of jurors in this case, received the diagnosis months after performing her civic duty. Four years ago, she was one of 12 jurors in the trial of Michael Rafferty, the man charged and convicted of kidnapping, sexually assaulting, and murdering Stafford.

While sitting on the jury during the two-month trial, the woman visited scenes of rape, saw photographic evidence of the crime, and heard eyewitness testimony from Rafferty’s girlfriend and accomplice, Terri-Lynne McClintic.

In a submission to the Ontario Court of Appeal, the juror said that, almost immediately after the trial, she lashed out at her children, suffered from depression, had flashbacks to disturbing pieces of evidence, and experienced short-term memory loss and difficulties with concentration.

Over the course of a criminal trial, jurors are often exposed to disturbing graphic evidence. And while jury members are instructed to remain unbiased and evenhanded, the process can take a toll on their mental health.

Beyond the traumatizing effects of graphic evidence, the weight of the task itself can be harmful to jurors’ wellbeing. The high-stakes decision that members have been tasked with, which includes determining the fate of someone’s life, can be psychologically taxing. This pattern of stress and anxiety is frequently observed in other high-pressure jobs that involve exposure to traumatic information and heavy responsibilities, such as social work.

Patrick Baillie, a psychologist with Alberta Health Services, and former Chair of the Mental Health Commission of Canada, says that jury members are often not mentally prepared to sit through a criminal trial:

“These are twelve citizens who don’t typically have any involvement with the system, which is why we want them to serve as jurors, being given this extraordinary task with not a whole lot of mental support.”

In addition to the responsibility of remaining impartial, jurors are not allowed to share any details related to their deliberations. To protect the integrity of the trial, members are prohibited from discussing their personal views on the evidence, witnesses, or trial process, to ensure confidential information cannot be related back to discussions that took place in the jury room. Baillie explains:

“It is illegal to disclose the deliberation of a jury to anybody. So, [you] can’t tell a spouse and family and friends… people in [your] usual support system and the mental health professionals that [you] may want to come in contact with down the road. We need to make sure that jurors are not identified and to make sure the process is pure as it can be.”

Under these circumstances, jury members are left to process the psychological and emotional effects of the trial on their own.

Barbara Legate, the lawyer representing the juror from Stafford’s case, argues:

“We ask jurors to sit through days, weeks, and sometimes months of testimony and sometimes that testimony is very, very difficult, and we ask them to keep it to themselves, not discuss it with people outside.”

Until recently, Ontario judges were responsible for deciding whether jurors should be offered counseling at the end of a trial. Jurors would then either be connected with counselors provided by the Ministry of the Attorney General or would pursue counseling on their own.

Starting in January 2017, however, Ontario initiates a new program to provide free and accessible counseling services to anyone serving on a jury. The Ontario Attorney General Yasir Naqvi says the Juror Support Program will be available for anyone serving in a criminal or civil trial, or an inquest.

Jurors will be provided with information on the program at the beginning of a trial, and then again as it finishes. They will call a designated phone number, speak to a specialist who does an assessment, and have counseling made available to them. A third party will provide and cover the costs of the counseling services, but the government still determines who that third party will be. Naqui says:

“Jurors in difficult trials do face evidence that could be quite horrific, and we’ve heard those stories. It’s only appropriate that we provide appropriate services.”

-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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Assisted Dying: We Need a Larger Conversation

00Aging, Caregiving, Decision-Making, Empathy, Featured news, Guilt April, 19

Source: Alberto Biscalchin at flickr, Creative Commons

We know that death is inevitable, yet most imagine it in the distant future. But those with a terminal illness face the harsh reality of death’s imminence. Cancer is the most common terminal illness, and in 2016, an estimated 1.5 million new cases will be diagnosed in the US, and almost 600,000 people will die from the disease.

Over the past decade, European countries such as Belgium and the Netherlands have legalized assisted dying. More recently, Canada passed Bill C-14 in June 2016, allowing assisted dying to be an option for those with a terminal illness. According to Health Canada, since the bill passed, there have been a total of 2,149 assisted deaths, and 63 per cent of them were cancer-related.

I lost my grandparents to terminal diseases, and saw what they endured. I wonder what choice they would have made had assisted dying been legal at the time. Both my parents believe that if someone is suffering, they have a right to end their life. As both of them had to care for their own ailing parents, they shared similar sentiments. In my mother’s words:

 “You feel frustrated, because you’re helpless. There is no cure and there is literally nothing you can do. You get very depressed, angry, and sad yourself. It’s also so hard to watch someone who was once so strong not be able to tie their own shoe anymore.” 

My father recalled a moment with my grandmother, when she could no longer bear her suffering. “I remember being in the kitchen with her and she put her head down on the table and said, ‘I just want it over with.’”

Since my paternal grandparents did not suffer long, my father does not think assisted dying would have been an option for them. My mother, however, feels differently and would have suggested it to her mother if the law would have been in place.

The right to assisted death provides some with relief. Barb Gibson Clifford, from Alberta, has stage 4 uterine cancer and in a short film by Dying With Dignity Canada, explains how this legislation impacts her:

“It’s terrifying to think that, if I don’t have choice, it could be very nasty, both for myself and for my family members. I’m so grateful to those nine judges of the supreme court for choosing to be in consensus about what they were doing. I cheered. I cheered in my kitchen.”

There are others who do not agree with their family members’ choice of assisted death. Former journalist, Deborah Binner from the United Kingdom, watched with inner turmoil and despair as her husband, Simon, made the choice to travel to Switzerland to end his life. This came after he received a motor neuron disease (MND) diagnosis. In her story, she explains how her husband’s choice made her feel:

“I didn’t want Simon to suffer but I didn’t want him to die, either. Watching him plan his own death, while I still wanted more time, was overwhelmingly traumatic. He had rights, but how much of his life was mine? I won’t join any campaign or celebrate his ‘choice’; nor would I condemn any other human being for making the same one.”

In a study of terminally ill patients in the United States, approximately 60 per cent supported assisted dying, but roughly 10 per cent considered it for themselves. Those who were more likely to consider it had depressive symptoms, essential caregiving needs (washing, eating, etc.), and pain. There are still some patients who do not make this choice for themselves. 

Michael Wenham from the United Kingdom, who also has MND, writes on his blog, “Investment in universal best palliative care is the true expression of compassion, not the offer of a cocktail of barbiturates, which is a perversion of therapy.”

With assisted dying laws being introduced in a number of countries, there is still a divide. It is a choice that affects many people and their communities. The conversations around Bill C-14 and other assisted dying laws tend to focus on ethics and morality. Yet, it is important that we recognize the human life behind these legislations. 

– Amanda Piccirilli, 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