Category: Education

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Ketamine Depression Treatment Poses Unknown Risks

00Decision-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

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Crushing Debt Affects Student Mental Health

60Anxiety, 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. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Crushing Debt Affects Student Mental Health

00Anxiety, 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. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Conversation Cards Help Therapists Dig Deeper

20Child Development, Education, Featured news, Parenting, Therapy, Trauma June, 17

Source: Michael on flickr, Creative Commons

As a counselor, social worker, or therapist, how do you begin conversations with your clients? What are the best ways to break the ice and generate meaningful discussions? These are questions that Jane Evans, trauma, parenting and behaviour expert, found to be common among her colleagues in the field.

Evans is a therapist and member of NEYTCO, the National Early Years Trainers and Consultants Organization, located in the UK. She has spent over 20 years working with parents and children who experience difficulty in relationships.

In an interview with the Trauma and Mental Health Report, Evans explains:

“I find that many practitioners don’t entirely understand childhood trauma and they struggle to talk to parents about it.”

To facilitate more open dialogue, Evans created Fink Cards—a conversation tool that provides structure to therapy sessions and helps therapists and clients engage in meaningful discussions. The Cards list questions to help parents who have trouble communicating and forming a good relationship with their children. And the Cards help parents and families who have encountered trauma in the past.

Since Evans sees trauma as a major factor in difficult parent-child relationships, she directly addresses this issue with the Fink Cards. They ask questions like “what does the word trauma make you think about?” to open the door to therapy work. The Cards support the counselor in facilitating discussion, and assist clients.

Evans found, while working with families, that parents are not always aware of how their own actions, as well as their interactions with the child, may in fact perpetuate problem behaviours. She says:

“Most parents see the child as the problem; they’re always aiming to fix the child. However, these cards invite them on a different journey. Parents consider what has happened early in their own lives or in their child’s early years and how that impacts their child’s behaviour now.”

Questions like “who was in charge of discipline when you were a child?” and “who notices when you are worried or anxious?” help parents reflect on how their early experiences and current support systems shape their parenting practices, as well as any negative impact these may be having on the child. As parents consider how these events impact their parenting choices, the therapist is able to work with them to implement more effective methods of communication and alternative coping strategies.

Research has shown that conversation cards can help patients become more open about their feelings. In a study conducted by researchers at Stratheden Hospital in the UK, 6D cards were used to facilitate holistic, patient-led communication. 6D cards are a type of conversation card developed to help physicians and nurses ensure a meaningful consultation with female patients in a gynecology clinic. They contain six categories, or dimensions, of health, including healthcare, emotions, lifestyle, interpersonal relationships, symptoms, and life events. The purpose of these cards is to allow the patients to lead the conversation.

Another study, conducted by the Design Council of the UK and the Bolton Primary Care Trust, focused on creating stronger methods of communication and management for diabetic patients with the use of Agent Cards, which are similar to both the 6D and Fink Cards. Agent Card statements encourage patient-led conversations with practitioners. Results of the study showed that using the cards helped facilitate more open discussion.

With Evans’ Fink Cards, clients have the freedom to choose questions from four categories during sessions: the parent’s early childhood and upbringing; the parent’s relationship with his or her child; the parent and child’s worries and anxieties; and how early trauma may have affected the child.

“These cards are a way of having difficult conversations, but it’s not just me putting the questions to the patient and saying ‘you have a problem,’” Evans explains.

While the effectiveness of Fink Cards does require more research, they have already made their way into the marketplace, and look to be a promising resource in clinical settings. Sometimes building rapport or discussing sensitive topics with a client can be difficult, but Fink Cards may go a long way in helping therapists and clients ease into healthy conversations in an educational and comfortable way.

–Afifa Mahboob, Contributing Writer, The Trauma and Mental Health Report

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

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Conversation Cards Help Therapists Dig Deeper

00Child Development, Education, Featured news, Parenting, Therapy, Trauma June, 17

Source: Michael on flickr, Creative Commons

As a counselor, social worker, or therapist, how do you begin conversations with your clients? What are the best ways to break the ice and generate meaningful discussions? These are questions that Jane Evans, trauma, parenting and behaviour expert, found to be common among her colleagues in the field.

Evans is a therapist and member of NEYTCO, the National Early Years Trainers and Consultants Organization, located in the UK. She has spent over 20 years working with parents and children who experience difficulty in relationships.

In an interview with the Trauma and Mental Health Report, Evans explains:

“I find that many practitioners don’t entirely understand childhood trauma and they struggle to talk to parents about it.”

To facilitate more open dialogue, Evans created Fink Cards—a conversation tool that provides structure to therapy sessions and helps therapists and clients engage in meaningful discussions. The Cards list questions to help parents who have trouble communicating and forming a good relationship with their children. And the Cards help parents and families who have encountered trauma in the past.

Since Evans sees trauma as a major factor in difficult parent-child relationships, she directly addresses this issue with the Fink Cards. They ask questions like “what does the word trauma make you think about?” to open the door to therapy work. The Cards support the counselor in facilitating discussion, and assist clients.

Evans found, while working with families, that parents are not always aware of how their own actions, as well as their interactions with the child, may in fact perpetuate problem behaviours. She says:

“Most parents see the child as the problem; they’re always aiming to fix the child. However, these cards invite them on a different journey. Parents consider what has happened early in their own lives or in their child’s early years and how that impacts their child’s behaviour now.”

Questions like “who was in charge of discipline when you were a child?” and “who notices when you are worried or anxious?” help parents reflect on how their early experiences and current support systems shape their parenting practices, as well as any negative impact these may be having on the child. As parents consider how these events impact their parenting choices, the therapist is able to work with them to implement more effective methods of communication and alternative coping strategies.

Research has shown that conversation cards can help patients become more open about their feelings. In a study conducted by researchers at Stratheden Hospital in the UK, 6D cards were used to facilitate holistic, patient-led communication. 6D cards are a type of conversation card developed to help physicians and nurses ensure a meaningful consultation with female patients in a gynecology clinic. They contain six categories, or dimensions, of health, including healthcare, emotions, lifestyle, interpersonal relationships, symptoms, and life events. The purpose of these cards is to allow the patients to lead the conversation.

Another study, conducted by the Design Council of the UK and the Bolton Primary Care Trust, focused on creating stronger methods of communication and management for diabetic patients with the use of Agent Cards, which are similar to both the 6D and Fink Cards. Agent Card statements encourage patient-led conversations with practitioners. Results of the study showed that using the cards helped facilitate more open discussion.

With Evans’ Fink Cards, clients have the freedom to choose questions from four categories during sessions: the parent’s early childhood and upbringing; the parent’s relationship with his or her child; the parent and child’s worries and anxieties; and how early trauma may have affected the child.

“These cards are a way of having difficult conversations, but it’s not just me putting the questions to the patient and saying ‘you have a problem,’” Evans explains.

While the effectiveness of Fink Cards does require more research, they have already made their way into the marketplace, and look to be a promising resource in clinical settings. Sometimes building rapport or discussing sensitive topics with a client can be difficult, but Fink Cards may go a long way in helping therapists and clients ease into healthy conversations in an educational and comfortable way.

–Afifa Mahboob, Contributing Writer, The Trauma and Mental Health Report

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

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Learning to Manage Emotions Boosts Children’s Well-being

20Child Development, Education, Emotion Regulation, Emotional Intelligence, Empathy, Featured news, Relationships February, 17

Source: holiveira on DeviantArt

English, Math, History, Geography…classes found in school curricula build foundational knowledge and promote future success.

Schools lay the groundwork for cognitive development, especially in academic areas. But what about emotional development? Proficiency in that is equally important for leading a successful life. Yet, little effort has been made in school to teach children how to manage their feelings.

With the introduction of RULER, this may not be the case for much longer. More and more schools around the U.S. are implementing the program aimed at teaching students—and teachers—to ‘Recognize, Understand, Label, Express, and Regulate’ emotions.

Supported by the Yale Center for Emotional Intelligence, it incorporates social and emotional skills training into the school curriculum to support child development. Specific curricula are available from kindergarten to grade 12, and ongoing implementation is necessary to solidify these skills as children get older.

“They’ve started to teach students about feelings as explicitly as they teach math and reading,” writes Seattle Times education reporter John Higgins.

The program is based on the work of two psychologists, John Mayer and Peter Salovey, who began their scientific study of emotional intelligence over two decades ago. They focus on a direct link between critical-thinking skills and emotions.

According to Meyer and Salovey emotional intelligence is the ability to identify, monitor, and manage the emotions of others and oneself, to guide actions and ways of thinking.

Studies show that those who are reluctant to understand and express their feelings experience higher levels of anxiety, depression, and certain psychiatric disorders. They also report lower levels of well-being and social support.

At school, children experience a wide range of emotions every day. In addition to the stress of managing their studies and homework, they face a number of social struggles, such as conflicts with friends, romantic relationships, and bullying.

Marc Brackett, Director of the Yale Center for Emotional Intelligence, and one of the developers of RULER, says that the way students feel at school has a profound effect on how they learn, influencing their chances of success at school, at home, and with friends. And some individuals are generally more successful at handling emotions than others.

Through different tools, RULER provides a common language for expressing emotions, for dealing with conflicts between students, and for addressing conflicts between students and teachers, making for an open and supportive environment necessary for learning. For example, the “mood meter,”—a sheet of paper divided into four coloured quadrants—is designed to help students build a vocabulary around different emotions.

“I have a teacher who checks in with the Mood Meter on Monday mornings and it’s nice to just know that someone’s listening. It gets us in the mood to work, eases us back into school,” explains a grade 11 high-school student in the program.

Other tools, such as the “meta-moment”, train students to use the few seconds following a moment of anger to take a deep breath and imagine how their “best self” would react.

One 7-year-old student talks about her experience with the meta-moment:

“When I’m not in a good mood, RULER can help me solve the problem. Like when my brother pushed sand on my sand castle and wouldn’t fix it. I felt really angry at him, but I took a meta-moment and realized it wasn’t hard to fix what he did and he didn’t do it on purpose. Then I felt a little more forgiving.”

Some are critical of social and emotional learning initiatives within a classroom setting, arguing that schools are not an appropriate venue for emotional education. Others emphasize the price-tag; an online resource and four days total of in-person training costs $10,500 per school (for up to three participants).

However, Brackett’s research shows that implementing RULER can improve a school’s climate while fostering positive development and academic achievement among its students. Some notable improvements include better relationships between students and teachers, more student autonomy and leadership, improved academic success, and fewer reports of bullying.

Students’ mental health profiles greatly improve as well. Kids and adolescents who are involved with this program have experienced reduced levels of anxiety, depression, aggression, hyperactivity, social stress, and alcohol and drug usage. And research shows how children’s ability to handle their emotions and to be mindful of others’ feelings has a significant effect on their mental health.

Not all children come with the tools necessary for academic and social success. Programs like RULER provide a platform for children to learn how to navigate emotional struggles, so they can leave their primary education with methods to succeed in their work and personal lives.

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

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Biased Publication Standards Hinder Schizophrenia Research

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

Source: Erin on Flickr

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

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

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

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

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

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

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

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

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

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

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

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

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

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We Thought You’d Never Ask: Autism and Self-Advocacy

00Autism, Education, Featured news, Humor, Intelligence, Positive Psychology March, 16

Source: Gerry Wurzburg at Wretches & Jabberers, Used with permission

“Not being able to speak is not the same as not having anything to say,” read the flat and emotionless voice of the computer. The author of these words, Tracy Thresher, is a 42-year-old man living with autism.

“Tracy, good job! I am landing on my bald head some good vibes from you,” added Larry Bissonnette, a 52-year-old autistic man and long-time friend of Tracy.

Since 2000, Tracy and Larry have been traveling the globe on a quest to redefine autism, offering an insider’s perspective on the disorder. Part of their fame comes from being among the first with autism to communicate through typing, at first relying on others to help them control their muscle spasms, but now writing independently.

Their goal is to change public and professional views on the disorder, including preconceptions about disability and intelligence.

During their travels, they stopped at York University in Toronto, Canada, where they presented a screening of their documentary Wretches and Jabberers, followed by a panel discussion. As audience members arrived, Tracy and Larry were already conversing with the event organizers by typing on their iPads.

At first, Tracy comes off as clumsy and quiet, while Larry seems lost in echolalia, the uncontrollable repetition of words commonly associated with autism, their outer appearance revealing none of the thoughtfulness and humour later conveyed in written form.

Larry views the main goal of his self-advocacy to make “intelligence seen as possible, no matter how weird you act or how little your speech is. Autism is not so much an abnormal brain, but abnormal experience. My difficulties are not with thinking and knowing, but with doing and acting.”

They have no oral language skills and engage in odd, uncontrollable rituals. Growing up, both were labelled ‘low-functioning autistics,’ presumed to be mentally retarded. They were excluded from normal schooling and faced the challenges of social isolation in mental institutions and adult disability centers.

Today, we know that including students with special needs in regular classrooms can greatly improve development and quality of life. Yet according to the Canadian Council on Learning, a large number of students with the disorder continue to be excluded from mainstream classrooms.

According to the Autism Society, 500,000 Americans with autism will reach adulthood in the next 10 years, but Tracy and Larry wonder whether we will find a way to embrace these individuals or if we will continue to marginalize them. Larry suggested that, “the problem isn’t autism, the problem is the lack of understanding of autism, lack of resources, interventions not being met with the person in mind, and assumptions being made about the person.”

Performance is often a reflection of the individual in context. Through their advocacy, Tracy and Larry say that sufferers of autism are more disabled by the environments they live in than their own bodies.

Tracy’s accomplishments are a testament to the potential that some with autism possess. He has presented at numerous local and national workshops and conferences, and has consulted to schools. He is also a member of the Vermont Statewide Standing Committee, and has worked for the Green Mountain Self-Advocates.

An artist, some of Larry’s notable achievements include his paintings, which are in the permanent collection at the Musée de l’Art Brut in Switzerland and in many private collections around the world. His work was most recently featured in the Hobart William and Smith Disability and the Arts Festival.

The goal behind their efforts is to encourage people to re-examine misconceptions about autistic people, and to allow educators, professionals, and the public to discover the individuals behind the label. This view aims not to romanticize the struggles of autism, but to promote the idea that if autistic individuals cannot learn within the current educational system, schools need to adapt.

Allowing these individuals to develop their own unique talents will help them thrive.

– Sara Benceković, 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

Distinct ADHD Symptoms in Girls Result in Under-Diagnosis

Distinct ADHD Symptoms in Girls Result in Under-Diagnosis

00ADHD, Adolescence, Education, Featured news, Gender, Parenting June, 15

Source: Ojo de Cineasta/Flickr

When my daughter was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) in the first grade, I was devastated. I didn’t see a hyperactive, impulsive child or one with behavioural issues. I apparently missed the symptoms, now making me wonder how many other parents also don’t know what ADHD looks like in girls.

It’s common to hear stories of young boys being overmedicated and over-diagnosed with ADHD. What we don’t hear is that for every boy diagnosed, there is a girl whose symptoms are being missed.

Patricia Quinn, developmental pediatrician and director of the National Center for Gender Issues and ADHD, says that girls with the disorder often exhibit symptoms in less physical and disruptive ways compared to boys. Girls are raised to internalize their emotions in North American culture, this is likely why they are more commonly diagnosed as having the ADHD inattentive subtype. Quinn notes that even girls with the ADHD hyperactive subtype do not show the same physical energy as boys do with the same subtype, but instead, exhibit symptoms like incessant talking, chewing on hair or clothes, being emotionally reactive or displaying hypersensitivity.

Similar to my experience, Katie, a mother of two girls living in Arkansas, found her daughter Katelyn’s diagnosis surprising. After Katelyn’s second grade teacher noticed her difficulty focusing and staying on task, a psychologist diagnosed Katelyn with the inattentive subtype of ADHD and mild anxiety.

“I thought Katelyn was just a little over-sensitive. She never acted too fidgety or anything. The most she did was talk incessantly, but that wasn’t a big deal,” says Katie.

Katie’s younger daughter, Violet, demonstrated intense and sometimes aggressive behavior. She was diagnosed at age six with combined type ADHD with aggression. The impulsive behavior showed up in Violet as being “mean” and sometimes acting like a bully.

Michelle, a single parent from Toronto, is currently in the process of having her eight-year-old daughter Lisa assessed. Having already been through the assessment process with Lisa’s older brother Nick, Michelle explains, “With Nick we were doing damage control whereas with Lisa, her behavior was more covert and not as extreme.”

Lisa, Katelyn, and Violet are fortunate to have been diagnosed early.

Most girls are not diagnosed until puberty, and even then, their symptoms can be mistaken for other disorders like depression, anxiety, and bipolar disorder. Quinn highlights that in a 2002 nationwide survey by Harris International, 14% of adolescent girls who had ADHD were [improperly] treated with antidepressants before their ADHD treatment, compared to only 5% of males with ADHD.

Even once a diagnosis is made, parents can go through various stages of denial, grief, and blame. Child psychologists, Alexandra Harborne and Miranda Wolpert at CAMHS in England, and neuropsychologist, Linda Clare, at the University of Wales Bangor say that it is common for parents to blame themselves for their children’s bad behaviour. In addition to dealing with self-blame, parents may unintentionally delay an assessment for their child.

In Katie’s situation, she says Katelyn’s grandfather did not believe that there was anything wrong with her, causing Katie to question her decision to have her daughter assessed as well as her choice of a medication based treatment plan. So too, Violet’s daycare initially attributed her misbehaviour to poor parenting, rather than an inability to regulate her emotions and behavior.

Receiving a diagnosis can bring relief to parents as it provides an explanation for the behaviors they’ve experienced. But, it can also cause grief as parents deal with the loss of a “normal” child and anxiety over what the future holds for the family.

A key part of the assessment process should include some support for the parents. But this is sometimes hard for parents to find. CHADD, Children and Adults with ADHD is a network throughout the U.S. and Canada that provides support groups and parenting classes. ADDitude magazine is another helpful resource. These networks allow parents to share the process of understanding the diagnosis and learning new parenting skills.

Michelle says that after researching ADHD she has come to see her children as simply being wired differently. She refers to the reactions and behaviours of ADHD as her child’s “guidance system”. She believes triggers occur when the environment or situation is a poor fit for the child, but that they can find what they need, and learn what to avoid.

Katie thinks that ADHD is not a problem per se, but part of who her children are. She considers her girls’ different ways of thinking as leading to creativity and innovation, underscoring the idea that a diagnosis of ADHD is not necessarily a negative label. As Michelle and Katie demonstrate, just being able to accept and understand the differences created by ADHD can be empowering. It’s neither a curse, nor a gift, just a different way of thinking.

Quinn notes that ADHD is highly treatable regardless of whether it is present in girls or boys.

What we need now is a better understanding of gender differences so we don’t miss early signs, and can better treat ADHD in girls.

– Heather Carter-Simmons, 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

A Contrast to Psychiatry: The ‘Hearing Voices’ Movement

A Contrast to Psychiatry: The ‘Hearing Voices’ Movement

00Conformity, Education, Featured news, Health, Identity, Psychiatry, Therapy May, 15

Source: Oiluj Samall Zeid / Flickr

The 1961 classic, The Myth of Mental Illness by Thomas Szasz, revolutionized the way we think about atypical mental phenomena.

And over the years, the diagnosis of schizophrenia has been criticized fervently, with some characterizing it as an umbrella term for separate psychological phenomena that vary in combination and severity from person to person.

Critics of the term have described the way experiences such as hearing voices are conceptualized and defined.  The International Hearing Voices Network (Intervoice) views hearing voices as a normal variation in human experience—albeit one of an unusual nature.

Representing a lesser known view within the field of mental health, the group encourages voice hearers to “accept that the voices are real, and to accept that the voices may have meaning (metaphoric or literal) based on one’s life experiences.”

In the interest of communicating different (and sometimes controversial) ideas in mental health, The Trauma & Mental Health Report recently spoke with a mental health nurse (who requested anonymity), whose current research examines voice-hearers’ narratives about their emotional experiences.  While not a member of Intervoice, the interviewee’s research represents an alternate approach to traditional psychiatry.

 Q:  Can you explain the structure and method of the narrative approach you are working on?

A:  Put at its most basic, I am following the method called ‘Dialogical Narrative Analysis’, outlined by Sociologist, Arthur Frank.  In my work, Dialogical Narrative Analysis examines the stories that voice-hearers have about their emotions and what those stories do for them.

Q:  How best do you think these experiences should be conceptualized if not as psychopathological?

A:  It would be best to ask those with the experience.  At the moment it seems as though they are greatly helped when they don’t dismiss their experiences as ‘illness’, but engage with them as meaningful.  Having seen the prolonged effects of both approaches over a number of years, I can say that it’s the voice-hearers and those with unshared beliefs [what we usually refer to as delusions] who clearly have the most to teach us.

Q:  Supporters of drug interventions often explain the use of pharmaceuticals for treatment as diminishing the occurrences of delusions or hallucination.  Can you comment on this way of thinking?

A:  It’s a normalizing practice; it seeks to return outliers to a normal.  I’m hardly the first to point out that what is considered normal is subject to extreme change.  This is how we get situations where persons and behaviours are rated as mad in one generation and acceptable in the next— like having a baby outside of marriage, or homosexuality.  This leads some in the Hearing Voices Movement to hope that what happened to the identity of being homosexual can happen to the identity of being a voice-hearer.

Q:  Does this point out a flaw in our cultural and scientific understanding of the meaning of ‘delusion’ and ‘hallucination’?

A:  The word ‘delusion’ is a judgment, and in the Hearing Voices Movement they tend to prefer the term ‘unshared belief’.  Many would agree that the problem with a ‘delusion’ is not so much in thinking, but in the interaction with humanity.  ‘Hallucination’ also implies a shared version of ‘real’ experiences which would be difficult to justify, a concept of normal which is utopian.

Many within the Hearing Voices Movement reject both terms.

Q:  Should therapeutic efforts end with the attempt to remove the occurrences of hallucinations or delusions?

A:  I think you can see now that I am not altogether in favour of ‘therapeutic efforts’.  Too often there is a lot of therapeutic effort, a lot of money, a lot of well-meaning people, and not very much thinking.  I am quite certain I would not like to be on the receiving end of ‘therapeutic efforts’.  I would like there to be justice and healing in communities.

Even if we were to know the complete neurological makeup of a voice-hearer’s brain, we would still lack true insight into the actual experience of hearing voices.  Understanding and accepting the lived experiences of these individuals is an indispensable tool for promoting coping and recovery.

It allows us to see the distressed individual not as some ‘gene-machine’ gone wrong, but a human who bears a certain relationship to himself and the world.

– Pavan Brar, 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