Depression | Psychotherapy Toronto - Toronto Psychologist

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

Mental-Health Stigma All Too Common in Iran

March 1, 201870Depression, Featured news, Health, Psychopathy, Stress, Trauma March, 18

Source: PakPolaris at Deviant Art, Creative Commons

A Minor Leap Down, an Iranian film featured at international film festivals in Berlin and Toronto, illustrates the struggle of a 30-year-old Iranian woman named Nahal, whose deteriorating mental health is undermined by her family.

When Nahal is told she’s had a miscarriage, instead of seeking support from her family—who have, in the past, refused to recognize her struggle with depression—she keeps the news to herself, leading to desperation.

Stigma surrounding psychological disorders in Iran often leads to isolation, as fear of judgment and ridicule creates barriers to pursuing treatment. Some reports show that 26.5 percent of Iranian women and 20.8 percent of Iranian men have mental-health difficulties.

In an interview with the Trauma and Mental Health Report (translated, Farsi to English), Hamed Rajabi, director of A Minor Leap Down, explains:

“This social system is only concerned with how people work and perform, and when that performance is lowered, their behavior is instantly condemned.”

Research by Ahmad Ali Noorbala and colleagues from Tehran University of Medical Sciences shows women in Iran have a greater incidence of mental disorders than women in Western cultures. One contributing factor may be that women in Iran are often confined to the home, leading to isolation and poor domestic conditions.

After the loss of her unborn child, Nahal spirals into deep depression, deciding not to remove dead fetal tissue from her womb. When she tries to address the issue with her mother and husband, she’s turned away.

Familial relationships and reputation are important aspects of Iranian culture. Mental illness in a family member is viewed as a familial flaw.

According to research published in the Journal of Health and Social Behaviour by Erin Cornwell of Cornell University and Linda Waite of the University of Chicago, social relationships are particularly important for those coping with mental illness; social withdrawal aggravates loneliness, stress, and feelings of low self-worth.

Nahal’s silence about her mental illness also relates to a worry that she’ll be forced to resume antidepressant medication, which she took prior to pregnancy. Medications like these are seen as first-line treatment in Iran.

In A Minor Leap Down, filmmaker Rajabi addresses the over-prescription of psychotropic medication in Iran, explaining:

“Depression signifies that a part of our lives hurt—and taking pills won’t solve anything until we distinguish which part of our life is causing the problem.”

Although recognition of mental-health problems in Iran has arguably increased over the past few years, considerable stigma still exists.

Awareness can translate to an enhanced understanding of the complexity of mental-health problems in a culture that holds rigid attitudes about mental health and illness.

–Nonna Khakpour, 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

Rape Victims’ Reactions Misunderstood by Law Enforcement

January 11, 201840Depression, Featured news, Law and Crime, Neuroscience, Post-Traumatic Stress Disorder, Trauma January, 18

Source: Richard George Davis, used with permission

In 2008, 18-year-old Marie reported being raped at knifepoint in her apartment. Confronted by the police with allegations that she was lying, she conceded under pressure that the rape may have been a dream. Then, after being aggressively interrogated about her story, she finally admitted to making it up. She was subsequently charged with false reporting.

The report, however, was not false. In June 2012, Marc O’Leary pleaded guilty to 28 counts of rape and was sentenced to 327½ years in prison, including 28½ years for the rape of Marie.

Rape is unlike most other criminal offences. The credibility of the victim is often on trial as much as the guilt of the assailant, despite the fact that false rape accusations are rare (only an estimated 2-8% of cases are fabricated).

Sergeant Gregg Rinta, a sex crimes supervisor at the Snohomish County Sheriff’s Office in Washington, deemed that what happened to Marie was “nothing short of the victim being coerced into admitting that she had lied about the rape.” Rinta recounted in an external report of the department’s handling of the case how Marie was subjected to “bullying and hounding”, as well as threats of jail time and withdrawal of housing assistance.

Steve Rider, the commander of Marie’s criminal investigation, considers her case a failure. In an interview conducted by ProPublica and The Marshall Project, he explained:

“Knowing that she went through that brutal attack—and then we told her she lied? That’s awful. We all got into this job to help people, not to hurt them”

The seed of doubt was planted when the police received a phone call from Marie’s former foster mother Peggy and another foster mother, Shannon. One of their biggest issues was that Marie was calm while describing the attack, rather than upset. Shannon stated:

“She called and said, ‘I’ve been raped. there was just no emotion. It was like she was telling me that she’d made a sandwich.”

Peggy remembers:

“I felt like she was telling me the script of a Law & Order story. She seemed so detached and removed emotionally.”

Hearing these accounts from those closest to Marie led the police to distrust her story, and the situation unfolded from there. In rape cases, a judgment of legitimacy often focuses on the victim’s reaction during and following the event instead of on the assailant’s behaviour.

Clinical psychologist Dr. Rebecca Campbell spoke about the neurobiology of sexual assault in a talk to the National Institute of Justice. She explained that victims are flooded with high levels of opiates during a rape—chemicals in the body intended to block physical and emotional pain, but which can also dull the victims’ feelings:

“The affect that a victim might be communicating during the assault and afterward may be very flat, incredibly monotone—like seeing no emotional reaction, which can seem counterintuitive to both the victim and other people.”

This misperception contributes to sexual assault cases not going to trial. Of rape cases that are reported, 84% are never referred to prosecutors or charged; 7% are charged but later dropped; 7% get a plea bargain; 1% are acquitted; and only 1% are ever convicted.

Dr. Campbell identifies part of this problem as the police misunderstanding victims’ reactions as they recount their trauma. Based on this confusion, police officers make assumptions about the legitimacy of what they hear and often discourage victims from seeking justice. Officers may even secondarily victimize them.

Secondary victimization is defined by Dr. Campbell as “the attitudes, beliefs and behaviors of social system personnel that victims experience as victim blaming and insensitive. It exacerbates their trauma, and it makes them feel like what they’re experiencing is a second rape.”

On average, 90% of victims are subject to at least one secondary victimization in their first encounter with the justice system. Victimization includes discouraging victims from pursuing the case, telling them it’s not serious enough, and asking about their appearance or any actions that may have provoked the assault.

These incidents have a profound effect on victims, as conveyed by Dr. Campbell, with many reporting feeling depressed, blamed, and violated. In fact, 80% feel unwilling to seek further help. As a result, many rape victims withdraw their complaint. To make matters worse, only 68% of rape cases are reported in the first place.

Sharing information on the neurobiology of trauma could be a powerful tool in educating police officers who don’t understand victims’ reactions. Evidence of the neurobiological changes that lead to flat affect or what appear to be huge emotional swings after an assault may help police better serve this population.

Furthermore, normalizing a range of reactions from rape victims, rather than accepting preconceived notions, may lead to a safer and more effective environment for reporting sexual assault. Knowledge about trauma can also serve to inform public discourse about sexual assault, as well as help victims to see their own reactions with compassion.

–Caitlin McNair, 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

Rape Victims' Reactions Misunderstood by Law Enforcement

January 11, 201800Depression, Featured news, Law and Crime, Neuroscience, Post-Traumatic Stress Disorder, Trauma January, 18

Source: Richard George Davis, used with permission

In 2008, 18-year-old Marie reported being raped at knifepoint in her apartment. Confronted by the police with allegations that she was lying, she conceded under pressure that the rape may have been a dream. Then, after being aggressively interrogated about her story, she finally admitted to making it up. She was subsequently charged with false reporting.

The report, however, was not false. In June 2012, Marc O’Leary pleaded guilty to 28 counts of rape and was sentenced to 327½ years in prison, including 28½ years for the rape of Marie.

Rape is unlike most other criminal offenses. The credibility of the victim is often on trial as much as the guilt of the assailant, despite the fact that false rape accusations are rare (only an estimated 2 to 8 percent of cases are fabricated).

Sergeant Gregg Rinta, a sex crimes supervisor at the Snohomish County Sheriff’s Office in Washington, deemed that what happened to Marie was “nothing short of the victim being coerced into admitting that she had lied about the rape.” Rinta recounted in an external report of the department’s handling of the case how Marie was subjected to “bullying and hounding,” as well as threats of jail time and withdrawal of housing assistance.

Steve Rider, the commander of Marie’s criminal investigation, considers her case a failure. In an interview conducted by ProPublica and The Marshall Project, he explained:

“Knowing that she went through that brutal attack—and then we told her she lied? That’s awful. We all got into this job to help people, not to hurt them.”

The seed of doubt was planted when the police received a phone call from Marie’s former foster mother Peggy and another foster mother, Shannon. One of their biggest issues was that Marie was calm while describing the attack, rather than upset. Shannon stated:

“She called and said, ‘I’ve been raped.’ there was just no emotion. It was like she was telling me that she’d made a sandwich.”

Peggy remembers:

“I felt like she was telling me the script of a Law & Order story. She seemed so detached and removed emotionally.”

Hearing these accounts from those closest to Marie led the police to distrust her story, and the situation unfolded from there. In rape cases, a judgment of legitimacy often focuses on the victim’s reaction during and following the event instead of on the assailant’s behaviour.

Clinical psychologist Dr. Rebecca Campbell spoke about the neurobiology of sexual assault in a talk to the National Institute of Justice. She explained that victims are flooded with high levels of opiates during a rape—chemicals in the body intended to block physical and emotional pain, but which can also dull the victims’ feelings:

“The affect that a victim might be communicating during the assault and afterward may be very flat, incredibly monotone—like seeing no emotional reaction, which can seem counterintuitive to both the victim and other people.”

This misperception contributes to sexual assault cases not going to trial. Of rape cases that are reported, 84 percent are never referred to prosecutors or charged; 7 percent are charged but later dropped; 7 percent get a plea bargain; 1 percent are acquitted; and only 1 percent are ever convicted.

Dr. Campbell identifies part of this problem is the police misunderstanding victims’ reactions as they recount their trauma. Based on this confusion, police officers make assumptions about the legitimacy of what they hear and often discourage victims from seeking justice. Officers may even secondarily victimize them.

Secondary victimization is defined by Dr. Campbell as “the attitudes, beliefs, and behaviors of social system personnel that victims experience as victim blaming and insensitive. It exacerbates their trauma, and it makes them feel like what they’re experiencing is a second rape.”

On average, 90 percent of victims are subject to at least one secondary victimization in their first encounter with the justice system. Victimization includes discouraging victims from pursuing the case, telling them it’s not serious enough, and asking about their appearance or any actions that may have provoked the assault.

These incidents have a profound effect on victims, as conveyed by Dr. Campbell, with many report feeling depressed, blamed, and violated. In fact, 80 percent feel unwilling to seek further help. As a result, many rape victims withdraw their complaint. To make matters worse, only 68 percent of rape cases are reported in the first place.

Sharing information on the neurobiology of trauma could be a powerful tool in educating police officers who don’t understand victims’ reactions. Evidence of the neurobiological changes that lead to flat affect or what appear to be huge emotional swings after an assault may help police better serve this population.

Furthermore, normalizing a range of reactions from rape victims, rather than accepting preconceived notions, may lead to a safer and more effective environment for reporting sexual assault. Knowledge about trauma can also serve to inform public discourse about sexual assault, as well as help victims to see their own reactions with compassion.

–Caitlin McNair, 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

Crushing Debt Affects Student Mental Health

January 4, 201860Anxiety, Career, Depression, Education, Featured news, Health, Politics January, 18

Source: thisisbossi at flickr, Creative Commons

Brian, a graduate from a university in California, struggled financially and emotionally. He often experienced anxiety, panic, and shame about his student loans.

Upon graduating, Brian moved to Germany, and to this point, has not paid back a cent of his debt. So long as Brian continues to live abroad, earns a living in a foreign country, does not pay U.S. taxes, and does not collect social security, loan companies are unable to contact him.

Brian’s story of “debt dodging” is just one way, albeit extreme, some students cope with the stress of educational loans, which play a very large role in higher education in North America. And Brian is not the only student who has left his home, family, and friends to escape.

In Canada, average student debt estimates hover in the mid-to-high $20,000 range. This estimate is close to the $26,300 figure that many students said they expected to owe after graduating, according to a recent Bank of Montreal survey.

When she was granted a large enough loan to pay for four years of university and one year of college, Aneeta (name changed for anonymity), a recent graduate of the journalism program at the University of Guelph-Humber in Canada, says she did not understand the consequences of accepting such a large sum of money.

In an interview with the Trauma and Mental Health Report, Aneeta explained:

“I really didn’t grasp the gravity of having so much financial assistance from the government, and then having to owe all that money back until after I actually graduated. And it was even more anxiety-provoking because I really struggled to find permanent, full-time work after leaving school.”

Since graduating, Aneeta still lives with her parents and has bounced between temporary retail jobs. The toll the debt has taken on her mental wellbeing includes frequent feelings of self-doubt, embarrassment, and even days of relentless anxiety and depression.

“Honestly, my plan after graduation was to score an awesome job in my field and save up enough money to move out and rent. I just forgot to consider the 25+ thousand dollars that I owe—which I think a lot of undergraduates do, to be honest with you. And every time I think of how much I owe and how much of a long way I have to be debt-free, it freaks me out. And then I feel guilty for spending the money I do have.”

Unable to afford much at all, Aneeta feels isolated and out of the loop; she seldom sees her friends. For students like Aneeta, high debt loads represent not only financial stress, but they can delay the time it takes to reach certain life milestones.

Denise Lopez, a registration and financial aid assistant at the University of Toronto (U of T), said in an interview with the Trauma and Mental Health Report:

“The number of former students I see who are well into their 30s and 40s and are still paying off their student loans is overwhelming. And many of them admit to being financially restricted from the things they really want to do like buy a car or property.”

Lopez distinctly recalls one U of T alumnus who shared his fear that, when his kids hit university age, he’ll still be paying off his own student loans. And with university tuition rising to record levels in Canada, his fears may not be unfounded.

According to research by the Canadian Centre for Policy Alternatives, the cost of a university degree in Canada is getting steeper, with tuition and other compulsory fees expected to triple from 1990 to 2017.

The mental wellbeing of students is not the only area affected by steep tuition and loans—their parents’ lives are also altered. For example, parents are postponing retirement and taking on additional debt to help put their children through school or pay off loans. In Aneeta’s words:

“My dad recently became an UBER driver to help me pay off my loans because I can’t do this on my own. I feel guilty. I can see the financial burden and stress in his face. If he had the choice, he wouldn’t want to be working on-top of the hours he puts in at his day job.”

–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

Crushing Debt Affects Student Mental Health

January 4, 201800Anxiety, Career, Depression, Education, Featured news, Health, Politics January, 18