Category: Depression

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One Woman’s Suicide Ignites the Right to Die Debate

00Aging, Dementia, Depression, Ethics and Morality, Featured news, Memory, Mental Health, Politics, Suicide November, 14

“I will take my life today around noon. It is time. Dementia is taking its toll and I have nearly lost myself.”

Gillian Bennett chose the right to die in the backyard of her home on Bowen Island. On August 18th, 2014, wrapped in the arms of her husband of 60 years, she said goodbye with a tumbler of whiskey and a lethal dose of barbiturates. 

At age 85, Bennett had been living with dementia for over three years. During her lucid moments, she would ruminate on the impact of her suffering on family, and the burden she would become on the healthcare system at large.

Bennett wanted to live and die with dignity; she viewed spending her remaining days in a nursing home as anything but.

The retired psychotherapist voiced her wish to end her life on her own terms before losing “an indefinite number of years of being a vegetable in a hospital setting, eating up the country’s money but having not the faintest idea of who [she is].” Her family and friends supported her decision.

“In our family it is recognized that any adult has the right to make her own decision.” 

Bennett’s conversations became the inspiration for deadatnoon.com, a website that hosts her goodbye letter. In it, Bennett explains her reasoning for wanting to die on her own terms and makes a plea to re-open the debate on assisted suicide for the elderly and terminally ill 

Every day Bennett felt she was losing another part of herself. Small lapses in memory were followed by an inability to keep the days straight and a decline in physical capacity. Soon, she would not have been competent enough to make decisions about her life. She wanted out before that happened.

She considered three options. The first was to “have a minder care for [her] mindless body” despite financial hardship on her family. The second, to settle into a federally funded facility at a cost to the country of $50,000 to $75,000 per year. The third, to end her life “before her mind [was] gone.”

She felt compelled to choose the third, dismissing the other options as “ludicrous, wasteful, and unfair.” At the end of her four-page letter, she encouraged readers to consider the ethics of assisted suicide.

Canadians are not unfamiliar with the debate on euthanasia. Beginning with the landmark Rodriguez v. British Columbia decision, euthanasia has been revisited by the courts many times.

In 1991, Sue Rodriguez, who was suffering from ALS, attempted to petition the Supreme Court of Canada to allow assistance in ending her life. The court refused her request.

Despite the decision, she passed away with the aid of an unknown doctor in 1994.

A similar ruling was made in the Robert Latimer case. Latimer was convicted of second-degree murder in 1997 after killing his severely mentally disabled daughter, Tracy, whose condition left her in constant, unmanageable pain. 

In 2011, the B.C. Supreme Court ruled that the ban on assisted suicide was unconstitutional following a challenge from another ALS sufferer, Gloria Taylor. The federal government appealed the ruling and, in 2013, the B.C. Court of Appeal upheld the ban.

Bennett’s decision to end her life revived the debate. Following the publication of Bennett’s letter, Conservative MP Steven Fletcher went on record saying that assisted suicide in Canada has never been properly debated in Parliament. 

Fletcher has recently introduced two private member’s bills on assisted suicide. One will allow physicians to help patients end their lives under certain circumstances. The other will introduce a commission to systematically monitor the practice. 

How these bills will fare in Parliament remains to be seen, but Fletcher claims they have a strong chance of passing a second reading and moving to the justice committee. Additionally, the Supreme Court of Canada began hearing arguments on October 15th, 2014 on whether to uphold or strike down the current ban on assisted suicide. 

Bennett, a woman who saw life as “a party she was dropped into”, made it clear she felt she was losing nothing by committing suicide. Described as smart, funny, and irreverent, she faced death the way she lived life. 

“Each of us is born uniquely and dies uniquely. I think of dying as a final adventure with a predictably abrupt end. I know when it’s time to leave and I do not find it scary.” 

– Contributing Writer: Magdelena Belanger, The Trauma and Mental Health Report 

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

Copyright Robert T. Muller

Photo by #300091984/Flickr

This article was originally published on Psychology Today

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No Place to Be a Child

00Anxiety, Child Development, Cognition, Depression, Education, Empathy, Environment, Featured news, Grief, Meditation, Mental Health, Resilience, Social Life, Stress, Trauma, Trauma Psychotherapy, Treatment October, 14

“If we are to teach real peace in this world, and if we are to carry on a real war against war, we shall have to begin with the children” – Mahatma Gandhi

Over 18 million children are currently living in regions affected by war. While most humanitarian aid groups focus on meeting the basic physical needs of these children, in the midst of armed conflict, cognitive, social and emotional development is often inhibited and overshadowed by regional chaos.

Exposed to violent, traumatic and stressful situations that threaten their sense of stability and well-being, children have few places to simply be children, where they can play, learn and socialize safely. And few resources are in place to help them heal from the psychological burdens of war.

As the need for rehabilitative and restorative measures gains greater recognition by the international community, a growing number of child rights advocates, organizations and researchers are stepping forward to understand the implementation of psychologically therapeutic programs for war-affected children. The challenge is in figuring out what is needed, what is available and what will work across a variety of cultures, contexts and settings.

Seeking to bring psychological care on a tight budget, academics and policy advisors have emphasized evidence-based programs. Theresa Betancourt, professor and director of the research program on children and global adversity at Harvard’s school of public health, and her colleagues are evaluating the effectiveness of child trauma programs based in countries such as Uganda, Sierra Leone, Chechnya, Gaza, Sudan, Kosovo, Bosnia and Croatia.

Individual therapeutic interventions such as trauma focused therapy and narrative exposure therapy have shown promise among children affected by war and are approved by UNICEF as preferred techniques.

Group interventions have been used to accommodate the psycho-social needs of a greater number of children. These include Interpersonal group therapy for depression, creative play, mother-child psycho-education and support, and torture group psychotherapy with cognitive behavioural techniques.

Some other psycho-social initiatives have focused on the creation of Child Friendly Spaces (CFS’s) and Temporary Learning Centers (TLC’s) within refugee camp settings or local communities. These provide a child-centered environment for play, basic education and socialization; and they identify children in psychological distress.

But some concerns have been noted. The focus on trauma can lead to community stigmatization. In addition, these therapies are hard to carry out on a large scale due to the high costs of employing highly-trained professionals. Individualized services are rare and reserved for severely distressed children, usually demobilized child soldiers.

Problems arise when trying to apply western definitions and measures of distress that are not necessarily applicable to other cultures and contexts. And in understanding any given child’s psychological functioning, it is important to factor in ongoing stressful events and the social dynamics that a war-affected child must deal with on a daily basis.

There has been a movement away from a traditional western “clinical treatment” model toward a more inclusive, holistic framework of “psycho-social intervention,” termed to reflect the complex interplay between a child’s psychological and social development.

More effective group interventions for children have tended to be those that involve a school setting, address everyday stressors, utilize a form of trauma/grief-focused psychotherapy or use mind-body relaxation and coping techniques such as meditation, biofeedback and guided imagery.

Benefits include decreases in posttraumatic stress disorder, improved coping skills, and greater psychological relief and psycho-social adjustment.

Still, universal, comprehensive, culturally-sensitive psychological services for war-affected children remain a long way off. For more information on mobile psycho-social and education programs for war-affected children, please check out The Freedom to Thrive Foundation. Email FreedomToThriveFoundation@gmail.com to find out how you can get involved.

– Contributing Writer: Adriana Wilson, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Dr. Mom and Dad

00ADHD, Anxiety, Attention, Child Development, Depression, Environment, Featured news, Intelligence, Leadership, Mental Health, Motivation, Parenting, Psychiatry, Psychopharmacology, Self-Control, Sleep September, 14

We live in a world of self-diagnosis. With access to online medical databases like WebMD and kidshealth.org, it is easy to type symptoms into Google, find a diagnosis and present findings to the family physician.

Self-diagnosis may seem harmless, but it can become problematic when we diagnose ourselves or our children with more complicated conditions, behavioral disorders like Attention Deficit Hyperactivity Disorder (ADHD).

The over-diagnosis of ADHD and the over-prescription of medications like Ritalin, Adderall, and Vyvanse (to name a few) have been longstanding problems in the health care community. Clinical psychologists Silvia Schneider, Jurgen Margraf, and Katrin Bruchmuller, on faculty at the University of Bochum and the University of Basel found that mental health workers such as psychiatrists tend to diagnose based on “a rule of thumb.” That is, children and adolescents -often males- are diagnosed with ADHD based on criteria such as “motoric restlessness, lack of concentration and impulsiveness,” rather than adhering to more comprehensive diagnostic criteria.

Parentsmotivation to get help for their child’s problems along with free access to online information may play a role in the over-diagnosis of ADHD.

A study by Anne Walsh, a professor of Nursing at Queensland University of Technology found that close to 43% of parents diagnosed and 33% treated their children’s health using online information. Of concern, 18% of parents actually altered their child’s professional health management to correspond with online information. Considering the questionable quality of some online health information, these numbers are worrisome.

Furthermore, as primary caregivers can sometimes be persuaded, it is possible that parental conviction of the child’s diagnosis may play a role in physician decisions to treat. With basic diagnostic criteria for ADHD readily available online, some parents may be quick to self-diagnose their “restless and impulsive child.”

“It sometimes happens that parents come to me convinced that their child has ADHD [based on their own research] and in many circumstances they are correct,” says Dan Flanders, a pediatrician practicing in Toronto, Canada.

 According to Flanders, there are certain traits that make a child more likely to be misdiagnosed with ADHD. “Children who have learning disabilities, hearing impairment, or visual impairment may be mistaken as having ADHD because it is harder for them to focus if they can’t see the blackboard, hear their teacher or if they simply cannot read their homework.”

Flanders adds that gifted children, children with anxiety or depression, and children with sleep disorders are commonly misdiagnosed with attention disorders. “Gifted children learn the class objectives after the first 10 minutes of a class whereas their classmates need the whole hour. For the remaining 50 minutes of class these children get bored, fidgety, distracted, and disruptive. The treatment for these children is to enrich their learning environment so that they are kept engaged by the additional school materials.”

Children with anxiety and depression can be misdiagnosed with ADHD because there may be an interference with a child’s ability to learn, focus, eat, sleep, and interact with others. For children with sleep disorders, “one of the most common presentations of sleep disorders is hyperactivity and an inability to focus during the day. Fix the sleep problem and the ADHD symptoms go away.”

It is, however, important to note that these disorders are not mutually exclusive of each other. “A child can have a learning disability, anxiety, and independent ADHD all at the same time.” 

While it is often beneficial for parents to consult online databases for background information, Flanders warns against relying solely on information found online because the information may not be up-to-date and cannot replace a thorough psychological assessment.

Why, then, do parents resort to this quick fix of information?

Walsh reported that parents use online health information for a range of reasons including feeling rushed and receiving limited general lifestyle guidance from their doctors.

Flanders points out that the doctor’s approach should always be to review the data honestly and objectively with parents and then openly present the treatment options available to them.

“The most important part of ADHD treatment is making sure of the diagnosis. There are so many children who are started on medication inappropriately. Throwing medication at the problem is not the answer unless the diagnosis is well established and the differential diagnoses have been exhausted.”

– Contributing Writer: Jana Vigour, 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