Depression | Psychotherapy Toronto - Toronto Psychologist

The Hidden Struggles of Animal Rescue Workers

September 11, 201900Animal Behavior, Depression, Featured news, Resilience, Suicide, Trauma September, 19

Source: 12019 at Pixabay, Creative Commons

During the civil war in Syria, veterinary surgeon Amir Khalil from the charity organization Four Paws International, travelled to Aleppo to rescue surviving zoo animals. Before the war began, the zoo was home to around 300 animals, yet by July 2017 only 13 remained. After months of intense negotiations with the Syrian and Turkish governments, local factions and warlords, and two dangerous rescue missions later, Khalil managed to save all 13 animals. Prior to this rescue, Khalil had rescued animals from conflict zones in Libya, Gaza and Iraq.

When tragedy strikes, most people think about the potential harm done to human lives. However, many care deeply about animals and are willing to put their lives at risk to save them. In fact, during Hurricane Katrina, of those who did not evacuate their homes, 44% did so because they did not want to abandon their pets.

Research has even shown that there are some circumstances in which people chose to save pets over humans. One study showed that 40% of people chose to save their own pet over a foreign tourist. Another study showed that when presented with a fictional news story, people cared more about crimes involving dogs and children than adults. A possible reason for this surprising finding was likely due to the vulnerable nature of animals. In fact Khalil felt compelled to rescue many animals in the past simply because the zoo animals were dependent on humans. In an interview with The Telegraph, he explained:

“Humans have the option to escape, but animals caged in a zoo don’t have this option. It was humans who brought animals to these places. They cannot speak, they have no political agenda, but they are messengers from the darkness, they bring hope.”

Other animal rescue workers express similar sentiments. Darren Grandel, Deputy Chief of the investigations department at the Ontario Society for the Prevention of Cruelty to Animals, explained in an interview with the Trauma and Mental Health Report (TMHR) that the most difficult part of his enforcement work is witnessing innocents being harmed:

“The animals, all the time, are the innocents. It’s not that they’ve chosen to engage in a type of activity that can harm them. The humans have done it to them. So a lot of the time you’re seeing innocent animals being harmed, sometimes in very horrific ways, in ways that you couldn’t imagine someone hurting another living thing. It can be very, very traumatic.”

When working on rescuing animals such as in the wake of a natural disaster, a similar type of trauma can be experienced. In a TMHR interview, Miranda Spindel, a veterinarian with 19 years of experience, including a decade with the American Society for the Prevention of Cruelty to Animals explained:

“On deployment, you are typically away from home and often working in conditions that are less than ideal. Sometimes, there are animal owners as well as animals involved, who may have experienced very stressful and emotionally challenging situations and require skilled and compassionate care, too. Often the work is physically as well as mentally challenging.”

Animal rescue work, though important, severely affects the mental health of these individuals. Humanitarian aid workers and first responders report high rates of depression, anxiety and PTSD. Animal rescue workers occupy similar roles, rescuing and proving aid to animals in distress and likely experience similar mental health problems. And, according to a study in the American Journal of Preventative Medicine, those in protective service occupations, including animal control workers, have the highest rate of suicide, at 5.3 per million workers.

Veterinarians and others individuals who work with animals also experience high rates of compassion fatigue. Compassion fatigue, also known as vicarious traumatization, refers to stress symptoms that result from providing care and empathy to humans or animals in distress.

Janice Hannah, Campaign Manager of the International Fund for Animal Welfare’s Northern Dog Project described one such experience in a TMHR interview:

“I remember visiting a rural shelter. The dogs were literally stuck in a poop filled fence, cold, wet and hungry. That was the end of shelter work for me – I had been to so many similar shelters around the world and am reminded of the sadness felt in those situations. Though those feelings dissipate over time, it never goes fully away. You end up building up more and more sadness and discomfort around all the animals that you see but can’t make a tangible difference about the circumstance.

There are some programs in place, such as support groups and internal services within organizations to help animal rescue workers recover from trauma. Yet, more needs to be done to better help individuals who have dedicated their lives to helping animals. Increased peer support and open communication without fear of stigma are required to better help individuals with mental health problems. Spindel emphasizes that preventative measures are equally important:

“Whether or not workers are suffering from mental health issues, the circumstances are generally enough, in my opinion, that mental health services and resources should be made available as a matter of routine. Trained support during the deployment – or even before – not just debriefing afterward – seems critical to building resiliency for this type of work.”

From enforcement officers to veterinarians, many different professionals work selflessly to rescue innocent animals from harm. With greater support services, these individuals will be better able to cope with the stresses of their job, enabling them to better help animals in need.

-Roselyn Gishen, 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

In Post-Secondary School and Homeless

August 29, 201900Depression, Education, Featured news, Loneliness, Productivity, Sleep August, 19

Source: liborius at Flickr, some rights reserved

Under the concrete, ivy-covered walls of many universities lies a disturbing phenomenon; homelessness. Many find it incomprehensible that homelessness would exist in these spaces, but it does. A study by Michael Sulkowski shows that student homelessness is growing at an “unprecedented rate,” with 1 million affected. Rising tuition costs, coupled with a higher cost of living, makes it unlikely that student homelessness will be resolved any time soon.

In an interview with The Trauma and Mental Health Report, Maya (name changed for anonymity), a fourth-year psychology major, explained what it was like living as a homeless university student:

“I would search for empty lecture halls to sleep in. I would adjust my sleep schedule by sleeping during the daytime and remaining awake at night, because it was much safer to do so.”

“I would carry my bags with me, which contained all of my belongings. Classmates and friends would ask me why I was always carrying my stuff around, but I was hesitant to tell them that I was homeless. I was afraid and ashamed of my living situation and did not want anyone to know. I was afraid that people would judge me and believe that I was to blame for my homelessness,”

When at school, Maya said that it was hard to focus on her studies and practice self-care, as her homelessness took top priority:

“I would try to do everything in my power to not bring attention to myself. I would not ask questions in class, and I would avoid making friends with other classmates. I felt sub-human and inferior. I found myself deteriorating both physically and mentally. My hair began to turn grey and greasy, my skin was pale, and my mental health was in shambles. I was so focused on my homelessness that my grades also began to suffer.”

Eventually, things got a little better for Maya, as she found a temporary place to stay:

“One of my friends was a student executive for a women’s advocacy club on-campus, and she told me that I could use the office to sleep. It was a relief because I was given food, menstrual pads and tampons, as well as a place to sleep. It really helped me to get back on my feet.”

Why does homelessness among university students seem to be an invisible issue? Stephen Gaetz, director of the Canadian Observatory on Homelessness and Professor at York University explained this issue in an interview with CBC News Toronto:

“The hidden homeless is a much different population compared to the homeless population that is seen in emergency shelters. Student homelessness is often overlooked because they pull all-nighters in school, take showers in the gym, and sleep on the couches.”

According to Sulkowski’s study, youth homelessness receives less economic resources compared to adult homelessness. Youth who experience homelessness encounter several barriers to their academic success and well-being, leaving them vulnerable. One barrier that Maya had to overcome was difficulty accessing on-campus resources:

“When I tried to access counselling services, the first thing they asked me was my address. I did not have one, so I used my mother’s address instead. Something as simple as an address was a large issue for me, which isn’t something that we think about too often.”

“But even when I tried getting help for my living situation, I was given the run-around. I would call one service, and they would refer me to another one. I honestly felt like no one cared and wanted to help me, so I stopped asking for help.”

And Maya’s story is not unique. Recently, one student at the University of Alberta shared his experience with homelessness, explaining that he “slept in parks or near malls” and would find himself “frequently accessing the university food bank.” Despite the number of anecdotes regarding student homelessness, there is no national approximation for the number of post-secondary students facing homelessness in Canada, and university-specific data are not currently available.

I asked Maya what she believed post-secondary institutions should do to address the growing issue of student homelessness, given her own experience:

“Firstly, I think that campuses should have services that allow students who are homeless to access these resources without having to provide sensitive personal information. Secondly, having a kitchen on-campus stocked with food so students can prepare their own meals. Oftentimes the food that is provided by the school’s food bank is not accessible because you need a fridge or stove in order to eat it.”

Student homelessness is a problem that goes unseen. For many who experience it, they resist speaking out for fear of being shamed by their circumstances and ridiculed by others.

-Zeinab Mohamed, 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

Post-Secondary School and Homelessness

August 29, 201900Depression, Education, Featured news, Loneliness, Productivity, Sleep August, 19

Source: liborius at Flickr, some rights reserved

Under the ivy-covered walls of many universities lies a disturbing phenomenon: homelessness. Many find it incomprehensible that homelessness would exist in these spaces, but it does. A study by Michael Sulkowski shows that student homelessness is growing at an “unprecedented rate,” with 1 million affected. Rising tuition costs, coupled with a higher cost of living, makes it unlikely that student homelessness will be resolved any time soon.

In an interview with The Trauma and Mental Health Report, Maya (name changed for anonymity), a fourth-year psychology major, explained what it was like living as a homeless university student:

“I would search for empty lecture halls to sleep in. I would adjust my sleep schedule by sleeping during the daytime and remaining awake at night, because it was much safer to do so.”

“I would carry my bags with me, which contained all of my belongings. Classmates and friends would ask me why I was always carrying my stuff around, but I was hesitant to tell them that I was homeless. I was afraid and ashamed of my living situation and did not want anyone to know. I was afraid that people would judge me and believe that I was to blame for my homelessness,”

When at school, Maya said that it was hard to focus on her studies and practice self-care, as her homelessness took top priority:

“I would try to do everything in my power to not bring attention to myself. I would not ask questions in class, and I would avoid making friends with other classmates. I felt sub-human and inferior. I found myself deteriorating both physically and mentally. My hair began to turn grey and greasy, my skin was pale, and my mental health was in shambles. I was so focused on my homelessness that my grades also began to suffer.”

Eventually, things got a little better for Maya, as she found a temporary place to stay:

“One of my friends was a student executive for a women’s advocacy club on-campus, and she told me that I could use the office to sleep. It was a relief because I was given food, menstrual pads, and tampons, as well as a place to sleep. It really helped me to get back on my feet.”

Why does homelessness among university students seem to be an invisible issue? Stephen Gaetz, director of the Canadian Observatory on Homelessness and Professor at York University explained this issue in an interview with CBC News Toronto:

“The hidden homeless is a much different population compared to the homeless population that is seen in emergency shelters. Student homelessness is often overlooked because they pull all-nighters in school, take showers in the gym, and sleep on the couches.”

According to Sulkowski’s study, youth homelessness receives less economic resources compared to adult homelessness. Youth who experience homelessness encounter several barriers to their academic success and well-being, leaving them vulnerable. One barrier that Maya had to overcome was difficulty accessing on-campus resources:

“When I tried to access counseling services, the first thing they asked me was my address. I did not have one, so I used my mother’s address instead. Something as simple as an address was a large issue for me, which isn’t something that we think about too often.”

“But even when I tried getting help for my living situation, I was given the run-around. I would call one service, and they would refer me to another one. I honestly felt like no one cared and wanted to help me, so I stopped asking for help.”

And Maya’s story is not unique. Recently, one student at the University of Alberta shared his experience with homelessness, explaining that he “slept in parks or near malls” and would find himself “frequently accessing the university food bank.” Despite the number of anecdotes regarding student homelessness, there is no national approximation for the number of post-secondary students facing homelessness in Canada, and university-specific data are not currently available.

I asked Maya what she believed post-secondary institutions should do to address the growing issue of student homelessness, given her own experience:

“Firstly, I think that campuses should have services that allow students who are homeless to access these resources without having to provide sensitive personal information. Secondly, having a kitchen on-campus stocked with food so students can prepare their own meals. Oftentimes the food that is provided by the school’s food bank is not accessible because you need a fridge or stove in order to eat it.”

Student homelessness is a problem that goes unseen. For many who experience it, they resist speaking out for fear of being shamed by their circumstances and ridiculed by others.

—Zeinab Mohamed, Contributing Writer, The Trauma and Mental Health Report

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

—Copyright Robert T. Muller

This article was originally published on Psychology Today

After Children Are Freed From Captivity

July 18, 201900Caregiving, 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

What Happens After Children Are Freed From Captivity?

July 18, 201900Caregiving, 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 of 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 ten 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

When Bipolar Disorder Brings Marital Distress

July 4, 201900Bipolar 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

When Doctors Are At-Risk for Suicide

May 17, 201900Burnout, 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

Asthma Brings Surprising Challenges

March 21, 201900Anxiety, Cognitive Behavioral Therapy, Depression, Environment, Fear, Featured news, Health March, 19

Source: Free-Photos at Pixabay, Creative Commons

During the summer of 2017, Adrian and his partner, Kayla, ventured out to explore the dense forest in a remote area of south-eastern Canada where they were vacationing. Hiking on a trail that took them deep into the woods, Kayla shouted back at Adrian, urging him to catch up. Turning to him, Kayla could instantly tell something was wrong. After a wave of panic, he collapsed to the ground, gasping for air.

As Adrian began to fade in and out of consciousness Kayla frantically dialed 911, despite knowing there was no cellphone service within miles of their location. They were completely isolated. Trying to provide comfort, all Kayla could say was, “This is not the end.”

Approximately 300 million people worldwide suffer from asthma. This inflammatory lung disease, which causes swelling of the airways and constricted breathing, can be life-threatening. Globally, 250,000 people die each year from the condition, and researchers have yet to find a cure.

Asthma is a common health concern, and the traumatic experience of an asthma attack can affect the emotional well-being of the sufferer and loved ones.

A Canadian study by Renee Goodwin and colleagues published in the Journal of Psychosomatic Research found that asthma is related to numerous mental health conditions, with the greatest links between asthma and posttraumatic stress disorder (PTSD), mania, and panic disorder. Using data from the World Health Organization, Kai On Wong and a team of researchers found that, globally, asthma is associated with depression and anxiety.

Alex Watford is not surprised by these findings. In an interview with the Trauma and Mental Health Report, he discusses the toll his asthma has had on his mental health, and provides insight into what it is like to experience an asthma attack:

“It feels like you’re drowning. All of a sudden, you’re not getting enough oxygen despite how much you try to breathe. While attempting to breathe, you can hear phlegm rapidly filling your lungs, slowly suffocating you. You then become light-headed and begin to lose vision while your body becomes weak and lifeless.”

With diagnoses that include PTSD, anxiety, and depression, Watford believes his psychological distress is largely due to his terrifying flashbacks that cause him to live in constant fear of the next attack; fear which in turn provokes a level of anxiety that makes breathing difficult.

Clinical health psychologist Laura Flower, and Senior Research Fellow at the University of Southampton, Ben Ainsworth, describe Watford’s experience as the ‘cycle of breathlessness,’ a factor that contributes to the “complex and bi-directional” association between asthma and mental health challenges:

“The experience of breathlessness is distressing; and it’s a normal reaction to be anxious about it. This anxiety then leads to an increased chance of breathlessness – which causes more anxiety.”

According to Flower and Ainsworth, the association between asthma and mental illness is further complicated by the complex relationships asthma sufferers have with their symptoms:

“Some people are deconditioned to them (e.g. “it’s just my lungs, it’s just me”) and therefore aren’t motivated to manage them. Other people find them really uncomfortable, and are unable to work or enjoy a satisfactory quality of life. Both of these can lead to social isolation, poor lifestyle factors, such as fitness, which in turn worsen asthma symptoms.”

Watford describes how his daily life has been impacted by the disease:

“Having asthma affects my everyday life, as it makes having to walk long distances, such as across campus, really tough. This often deters me from going to class because I will feel so exhausted afterwards that attending feels useless. I often find myself avoiding many other activities for this same reason.”

In a UK-based asthma community forum, members offer further insight into asthma’s invasive nature and speak to the unpredictability and uncertainty of life with asthma.

“You don’t know what to expect tomorrow. Will you be able to breathe? Will there be someone there wearing strong perfumes or aftershave? Is there dust in the air? Oh, and just the sheer tiredness of it all, the worrying, not being in control of your surroundings…”

Some members say they are unable to perform simple tasks, such as walking up staircases or showering. Asthma sufferers describe the impact of the disorder as “genuinely life destroying and heart breaking”.

Complicating matters further is the stigma associated with asthma, resulting from a lack of awareness and understanding. The stigma can lead to improper management of the disease, as well as social isolation that creates further mental health challenges in asthma sufferers.

This is a theme that comes up in the asthma community forum:

“…sometimes we trivialize asthma as a society. It makes us think our illness isn’t that bad and so all the problems associated with it aren’t genuine.”

Clinical health psychologist Stacy Thomas, shares some of the ways psychologists, like herself, help asthma sufferers cope with the mental health aspects of chronic disorders, including asthma:

“Using therapeutic interventions, health psychologists help to eliminate the psychological barriers that moderate the experience of asthma. For example, cognitive behavioural therapy, considered the ‘gold standard’ in terms of therapeutic approach, examines the thoughts and beliefs that contribute to problems with mood or anxiety, the tools one can use to find more balance in their thinking, and the behaviours that might need to be changed.”

Adrian survived his close call that summer hiking in the woods. But like many others, he continues to re-live the attack with great intensity and struggles with the anxiety that such an experience leaves. Sometimes Adrian forgets that he suffers from asthma. For now, Adrian tries to remain positive, while patiently hoping for a cure.

-Julia Martini, 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

Mental Illness in Youth Often Goes Undetected

December 27, 201800Adolescence, Anxiety, Child Development, Decision-Making, Depression, Emotion Regulation, Featured news, Health December, 18

Source: Zarina Situmorang at DeviantArt, Creative Commons

When university student Kinga (name changed) was young, she struggled with symptoms she couldn’t identify. She had shortness of breath and would suddenly get anxious. Her mother took her to a doctor, and Kinga was diagnosed with asthma. Despite asthma treatment, her inability to catch her breath persisted, and she had feelings of panic.

In retrospect, Kinga isn’t so sure she had asthma at all, believing she was misdiagnosed. In an interview with the Trauma and Mental Health Report, she explains:

“The doctors never knew what was wrong with me, probably because I didn’t have the right words to explain what was happening, and maybe because I wasn’t failing in school.”

Some mental illnesses, even those that are familiar, such as anxiety and depression, can be hard to identify. For youth with subtle to moderate symptoms, diagnosis can be especially difficult. Psychiatrist Peter Jenson and colleagues emphasize that diagnoses tend to rely on adults noticing symptoms. Children and teenagers often don’t have the knowledge to recognize their own mental-health difficulties.

As Kinga entered her pre-adolescent years, she always felt tired. Everything she did took a little more effort. While she continued her day-to-day activities, her symptoms followed her around. She says:

“I always performed well in school. I went out with friends, attended dance and language classes, but the fatigue was almost too much to bear. I had to fight the fogginess in my head to concentrate in school, and push myself through the exhaustion in dance class.”

Struggling pre-teens may not even realise that their mental health is at risk. They might only feel a little more tired or pessimistic. But these symptoms can hinder their ability to perform to their full potential.

Kinga also experienced other symptoms, like irritability:

“Sometimes, I would scream at my parents or siblings over the smallest things. My mom called it ‘being a teenager’, she didn’t realise, none of us realised, that it was more than that.”

Despondent and unable to get help, Kinga took matters into her own hands and researched her symptoms on the Internet. She recalls:

“I was so fed up with feeling like this. So I turned to Google. I searched ‘what is tiredness a symptom of?’ In my 16-year-old mind, that was all it was. I was just tired. I clicked on a link— ‘symptoms of depression.’ Other symptoms listed were feelings of hopelessness, negative thoughts, difficulty concentrating, feelings of numbness… I suddenly realised what must be going on.”

With this new information, she went back to her doctor.

“I finally had a name for these feelings. But for so long, I was doing too well for anyone to notice something was wrong. I suffered for years, believing that everyone felt like this—everyone felt a little out of breath, a little empty.”

A form of depression where people appear to function normally is called dysthymia, and it often begins in childhood. Although it may not be as debilitating as major depression, dysthymia can prevent positive feelings and interfere with daily tasks. On average, it lasts five years, does not usually resolve on its own, and requires treatment. About 75% of those with dysthymia develop severe forms of depression if left untreated.

While Kinga’s symptoms did not prevent her from continuing her usual activities, if she had not received help when she did, she may very well have developed a more serious mental illness.

In a post on Up Worthy, college student Amanda Leventhal shares a similar experience. Four years passed before she was diagnosed and treated. And Leventhal believes the process took so long because of stereotypes regarding mental illness:

“Even though we’re often told that mental illness comes in all shapes and sizes, I think we’re still stuck with certain ‘stock images’ of mental health in our heads.”

She says that ideas of how mental illness “should look” are so prevalent, it is difficult to believe that someone who doesn’t look mentally ill could be struggling. In fact, a study out of Duke University reports that only half of teenagers with mental health problems receive treatment at all.

Kinga says:

“I don’t know where I would be today if I didn’t get help. I don’t even want to think about that. I know I’m not the only one who suffered from mental illness as a kid, so I hope there is an increase in awareness of mental illness in young people.”

– Anika Rak, 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

Ketamine Depression Treatment Poses Unknown Risks

November 4, 201800Decision-Making, Depression, Education, Featured news, Health, Psychopharmacology, Suicide November, 18

Source: SnaPsi at flickr, Creative Commons

New evidence that ketamine, an anesthetic medication, might be effective in treating depression is leading to increased research on the drug. What’s significant is the rapid relief in symptoms seen in some patients. After just one dose of ketamine, their depression can decline within three days, much quicker than with conventional anti-depressants.

This finding is particularly meaningful for people at risk for suicide. Ketamine may provide an option for physicians to quickly treat acutely suicidal patients by creating a window of opportunity to begin long-term behavioral and pharmacological therapies. If a patient’s symptoms are relieved even for a short time, it may be long enough to intervene.

Recent excitement also surfaced when researchers from New York’s Mount Sinai School of Medicine demonstrated the drug’s ability to alleviate treatment resistant depression (TRD). TRD occurs when feelings of intense sadness, loss of energy, and inability to experience pleasure persist even after multiple attempts at treatment. In the study, a shocking nine out of 10 patients with TRD experienced significantly reduced symptoms after their first dose of ketamine.

Despite this finding, questions remain about the drug’s long-term efficacy, as well as its side effects.

Anthony (name changed) has first-hand experience with ketamine to treat TRD. In a Reddit thread and interview with the Trauma and Mental Health Report, he explained that, prior to receiving ketamine treatment, he had tried numerous anti-depressants. After spending weeks or months on each drug to no avail, his doctor would switch him to a new drug in hopes of finding one that worked, but nothing did. Anthony began researching alternative treatments himself. He explained:

“When you try so many drugs—SSRIs, SNRIs, TCAS, antipsychotics, lithium, depakote—you are pretty open to anything that will help.”

He discovered ketamine and was enticed by the prospect of its therapeutic benefits:

“Before ketamine, I was in a hole. This was as depressed as I had ever been. I was suicidal. I called my mom and dad. They rescued me, letting me live in their basement. There, I began researching ketamine until I knew almost every study. I convinced my doctor to let me try it.”

But ketamine is only approved for use as an anesthetic by the U.S. Food and Drug Administration (FDA). This provision means that any patient who receives ketamine treatment for depression must have it prescribed as an “off-label” treatment. In other words, the doctor prescribes the drug for a non-FDA-approved use.

Choosing to participate in an unapproved treatment may expose a patient to more risks than they are aware of. FDA approval for ketamine use in anesthesia indicates that one time treatments are not harmful, but it is uncertain whether repeated treatments are safe. And, the long-term effects are not known.

Not surprisingly, the off-label prescription of ketamine has been criticized. A study by Melvyn Zhang at the Institute of Mental Health in Singapore and colleagues cited multiple problems with ketamine treatment for depression. A major criticism was that current information is based on inadequately short periods of observation. These observations indicate depression relapse rates as high as 73% one month after treatment ends.

Nevertheless, after deciding he was scared, but prepared to do anything to overcome his depression, Anthony began intravenous (IV) ketamine treatment in his doctor’s office:

“[When taking the drug] I feel completely disconnected from my body. I cannot move. I feel partly elated, and partly terrified. Reality becomes distant. I have no awareness of my body; only my mind exists. In this space, I can see my own struggle with depression. I recognize in this strange way that the depression isn’t real, not a part of me. I realize that I am surrounded by people who love me. Slowly, I come back to the chair I’m in, back to the doctor’s office. Somehow, I already feel better.”

After his initial treatment, Anthony said that his thoughts of suicide disappeared. He remembers feeling clear-headed, not high or euphoric. He felt normal again. This realization was so profound, he was moved to tears:

“After the initial five treatments, I was having moments when it felt like all my symptoms of depression were gone. But they would always eventually return. I was prescribed a nasal spray about a month after my last IV treatment. That worked for a while.”

Unfortunately, these benefits had serious contraindications. Anthony experienced lingering feelings of being disconnected from his body and from reality. Another study investigating ketamine use for TRD found that three out of 10 participants experienced dissociative symptoms from the drug.

These side effects have yet to be fully understood. Although Anthony believes that the treatment saved him, it also opened the door for other mental-health problems:

“Looking back, I would do it over again, as ketamine literally pulled me from suicidal thoughts. But, in my opinion, ketamine opened the door for the feelings of disconnection. And they are a huge struggle for me every day now.”

With alarmingly high post-treatment relapse rates, little knowledge of long-term safety, and worrisome side effects, ketamine has yet to be proven as a lasting treatment for depression.

– Stefano Costa, 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

Category: Depression