Embarrassment | Psychotherapy Toronto

Pressures to Breastfeed Can Harm Maternal Mental Health

January 24, 201900Child Development, Decision-Making, Embarrassment, Featured news, Guilt, Health, Parenting, Postpartum, Stress, Suicide January, 19

Source: sevenfloorsdown at DeviantArt, Creative Commons

Florence Leung of British Columbia, Canada went missing on October 25, 2016 while struggling with post-partum depression. Less than a month later, her family discovered that she had taken her own life, leaving behind a husband and infant son.

In an emotional public letter, Leung’s husband Kim Chen wrote an impassioned plea to new mothers asking them to seek help if they felt anxiety or depression. He also revealed that his wife’s difficulties with breastfeeding, and the resulting feelings of inadequacy, likely contributed to her condition. Urging women not to criticize themselves about an inability to breastfeed or a decision not to breastfeed, Chen wrote:

“Do not ever feel bad or guilty about not being able to exclusively breastfeed, even though you may feel the pressure to do so based on posters in maternity wards, brochures in prenatal classes, and teachings at breastfeeding classes.”

Speaking with the Trauma and Mental Health Report, Melissa (name changed) said that she was struck by Chen’s words, and recalled the scrutiny around breastfeeding she experienced with her first child:

“I was tired, sore, and the baby was cranky and constantly wanting to feed. It surprised me that, despite my vocal frustration and obvious difficulty breastfeeding, the nursing staff and lactation consultants were adamant that I continue to breastfeed exclusively.”

The frustration worsened once the couple returned home. The week that followed was exhausting, spent trying to calm a screaming newborn who constantly wanted to feed. The couple attended several breastfeeding clinics that reiterated the same message: breast is best. Melissa and her husband felt confused and defeated.

Shortly thereafter Melissa became completely overwhelmed:

“I began to get scared, and not trust myself. My inability to easily nurse and soothe my baby without intense discomfort led to feelings of failure. My emotions were overwhelming. I wasn’t sleeping because I was constantly pumping breastmilk or nursing.”

Within a week after giving birth, Melissa’s infant was suddenly much quieter and less agitated. Upon closer examination, she noticed that the baby looked pale, and was lethargic and dehydrated. A frantic trip to the emergency room (ER) revealed the newborn was not getting enough liquids and nourishment—despite the many scheduled feedings. Melissa said:

“When the ER doctor apologized for the miscommunication and advised us that supplementing with formula is not only okay, but sometimes necessary, I felt a mixture of relief and betrayal. Relief because I knew we would be okay, yet betrayed by some health professionals who put their personal agendas above our health and well-being.”

In an interview with the Trauma and Mental Health Report, Diane Philipp, a Child and Adolescent Psychiatrist at SickKids Centre for Community Mental Health in Toronto, shared that she meets many mothers suffering from stress, shame, and guilt associated with breastfeeding. Philipp explained that the judgements of others place unnecessary pressure on mothers:

“It’s important for mothers to have access to frank and open discussions that are safe and non-judgemental where they can seek out information and make the most knowledgeable decision that is best for their child and for themselves in terms of breastfeeding.”

Every woman’s situation is unique. Lifestyle habits, medication use, and medical and psychological history can complicate the post-partum experience. With this context in mind, the healthcare team should provide a comfortable environment—free of judgement—when discussing post-partum issues, including how to provide an infant’s nourishment.

For mothers who are unable to nurse, be it for medical, physical, or personal reasons, their decision can be supported and honoured in a way that promotes emotional well-being and encourages healthy parent-child bonding. Philipp said:

“For parents who can’t breastfeed for whatever reason, wonderful attachment bonds can still be made. Breast milk is not the only ingredient in a valuable, long-lasting relationship.”

Melissa, now a mother of two healthy school-age children, remains sensitive to others’ assumptions of breastfeeding:

“I felt so pressured to get it right, and so judged when I couldn’t provide for my child. Even when you come to terms with your decision not to breastfeed, people question your choice. Looking at my children today, I know I did the right thing.”

– Kimberley Moore, Contributing Writer, The Trauma and Mental Health Report.

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

-Copyright Robert T. Muller

This article was originally published on Psychology Today

What if Your Father Were a Pedophile?

August 30, 201800Embarrassment, Family Dynamics, Featured news, Psychiatry, Punishment, Relationships, Trauma August, 18

Source: Feature: enki22 at flickr, Creative Commons

“Between You and Me,” a documentary by director Chase Joynt, examines what it feels like to discover a family member has done a terrible thing. In this short film, Chase accompanies his friend Rebekah Skoor as they travel to visit Rebekah’s father, Michael, a convicted pedophile.

Michael Skoor, a pastor and family man, was convicted of repeatedly molesting an 11-year old boy. After contemplating suicide, he confessed the abuse to a psychiatrist, who reported him. Michael turned himself in, pled guilty, and was sentenced to 29 years in prison. For many, the story ends there, but for Rebekah and her family, the story just begins.

After her father’s revelations, Rebekah and her family faced social ostracism and stigmatization from their community. And, they felt their own feelings of shame. These repercussions often fall on families of sex offenders. “It was a really scary time,” Rebekah recounts to Chase in the film, as they prepare to travel to see her dad in prison.

A study by Professors Jill Levenson and Richard Tewksbury reported on data from family members of sex offenders. These families experienced financial hardship, housing displacement, and psychological distress. They also met with social repercussions, such as ridicule and teasing, as a result of their loved one’s actions.

In addition to feeling humiliation and shame, family members feared for their personal safety. Of all participants studied, 44% reported they had been threatened or harassed by a neighbor. Children of offenders suffered from depression and anxiety due to being bullied at school by both teachers and fellow students.

The public’s animosity toward these families may have its roots in the belief that family members know about the relative’s crimes, and could have intervened to stop them. It’s not uncommon for some members of law enforcement, the media, and the helping professions, to voice such assumptions, which may influence public opinion.

In an opinion piece by psychologist Seth Myers, he portrays the wife of disgraced football coach Jerry Sandusky as a guilty party to her husband’s crimes, even though she was never charged for any part in the assaults. And, Myers had never clinically assessed Sandusky’s wife. The assumption of guilt-by-association is a dubious claim to make, and may be at the heart of stigma faced by family members of sex offenders.

In an interview with the Toronto Star, psychiatrist Paul Fedoroff refers to the family members of sex offenders as “secondary victims.” These people are often abandoned and left reeling in the aftermath of the crime.

Families must also deal with their own personal feelings and internal conflicts. In the Toronto Star article, Scott Woodside, of the Sexual Behaviours Clinic at the Centre for Addiction and Mental Health (CAMH) in Toronto, explained that children of sexually abusive fathers “don’t like that their father did this to them but they love their father… and do not want their father to be taken away because no one will replace him.” The same can apply when parents abuse outsiders.

While acknowledging the seriousness of the crimes committed by these sexual predators, their families are confronted with the difficult task of trying to reconcile their good memories with the knowledge of the terrible act the relative committed. They are caught in the middle.

And to them, the offense is hard to integrate. In a deleted scene from “Between You And Me,” Rebekah explains her difficulty in trying to convey this dichotomy to others when speaking about her father:

“I feel called to give the back story of the 21 years of awesomeness that was in my life. Not perfection, but good intentional fathering. Before I land this heinous offense on people… I want them to be able to hold with me my dichotomy, that he is in some part hero and in some part this fallen man.”

Rebekah wants to illustrate both sides of her father, the man she knew, and the crimes he committed. Recognizing these two seemingly incompatible aspects leaves Rebekah feeling she is caught between loving her father and condemning his actions. Rebekah’s recollection of his sentencing illustrates the issue well.

“It felt very divided… the people with the ribbons who were there for the [victim] and the people without ribbons who were there for my dad. I really felt this profound sense of, ‘I also want a ribbon. I’m not pro sexual violence. I’m not endorsing my father’s actions.’”

She does not approve of what he did. And yet, “The terrible things don’t undo the love.”

– 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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Sexual Freedom: Only Part of the Equation for LGBTQ Refugees

July 21, 201620Anxiety, Embarrassment, Featured news, Loneliness, Resilience, Sexual Orientation, Stress July, 16

Source: Eric Constantineau on Flickr

Montgomry Danton is a gay man from the Caribbean island of Saint Lucia. In June 2014, he fled persecution in his home country to claim asylum in Canada because of his sexual orientation. By September 2014, he had been granted refugee status under the Immigration and Refugee Protection Act of 2002.

Leading up to his official hearing at the Immigration and Refugee Board, Danton experienced the fear and anxiety common to many LGBTQ asylum seekers. He reported feeling isolated and depressed, being unable to sleep or eat, and experiencing thoughts of suicide. At one point, Danton wanted to give up and return home to Saint Lucia, despite the danger this would have posed to his life.

One might imagine that after a successful refugee hearing, the difficult part would be over. It would be time to start building a new life in Canada. But for Danton, and others like him, the struggle to become established in a new country can be as stressful as the claims process itself. In an interview with the Trauma and Mental Health Report, Danton said:

“It was a relief to know I can actually stay in Canada to be who I really am and be comfortable with myself and also my sexuality. People think coming to Canada is a good thing, you know? But you have to prepare for challenges.”

Some challenges are broad, ranging from finding affordable housing, to gaining employment, to securing basic necessities like food and clothing. But others are more specific to individual circumstances, including language barriers and cultural unfamiliarity.

LGBTQ refugees, in particular, may continue to experience social isolation, perpetuating a sense of danger and persecution. Individuals who have undergone physical and emotional trauma may not be able to move past their experience and attain a sense of personal safety until they establish a support system in Canada.

For Danton, building a new life has been stressful, edging him back towards the depression he experienced during the refugee claims process, and before that, in Saint Lucia:

“There are certain times I just wish I was back home because if I was back home I would be comfortable living my life.”

He, like many others, has been struggling with the concept of ‘home.’

In Saint Lucia, Danton did personally meaningful work as an outreach officer for the LGBTQ organization, United and Strong, and lived with his partner. In Canada, he is unemployed, has moved four times since his arrival, and has been dependent on the assistance of acquaintances and friends.

“In Saint Lucia, if it was safe for me to be who I am, to show that I’m gay, I wouldn’t think about coming to Canada. I would have stayed.”

For Danton, and for other LGBTQ asylum seekers, safety, security, and freedom of expression are only a few aspects of a meaningful existence. As a refugee, he has had to sacrifice many other significant parts of his former life, which is a common tradeoff for many in his position.

And the choice between freedom of sexual expression and stable housing and employment is an unimaginably difficult one to make, as is the choice between safety from persecution and the comforting presence of friends and family back home.

Still, Danton emphasizes his gratitude and appreciation at being granted asylum. He is happy to feel safe, to be far from the persecution he experienced on a daily basis in Saint Lucia, to be accepted into a country like Canada where he hopes to reclaim his life.

“At the end of the day, I’m still grateful and I’m trying my best to not let the challenges get the best of me. I’m thinking about moving forward.”

– Sarah Hall, Contributing Writer, The Trauma and Mental Health Report

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

This article was originally published on Psychology Today

South Koreans Use Suicide to Preserve Honour.

December 24, 201510Depression, Embarrassment, Featured news, Health, Stress, Suicide, Therapy December, 15

Source: Tanla Sevillano on Flickr

The suicide of a celebrity comes as a shock to fans. In the wake of Robin Williams’ death, there was an outpouring of grief. But suicide, like many aspects of mental health, varies across cultures. In October 2008, one of South Korea’s leading actresses and national icons, Choi Jin-Sil, hanged herself.

The importance of honour in Korean culture is evident throughout Choi’s story. She often spoke of the stigma of being a divorced, single mother in the public eye, which a national entertainment columnist likened to having a personality disorder. The divorce itself was a result of domestic abuse, yet a court cited Choi’s “failure of her contractual obligations” and inability to “maintain dignity and proper social and moral honour” in its ruling.

Choi’s death was only the beginning. It led to a wave of sympathy suicides in 2008, causing a 70% increase in suicides that October. In March 2010, Choi’s younger brother killed himself by hanging, and her ex-husband also hanged himself in January 2013.

This rash of suicides is exemplary of a common Korean belief: Psychological treatment is viewed with skepticism. An interview withKyooseob Ha, a psychiatrist with Seoul National University of Medicine, describes how Koreans are averse to seeking therapy, even for severe depression. Admitting to depression is seen as a character failure, shameful to the family. It is often concealed.

The same cultural norms dictate that preserving family reputation is paramount. Families asked about their loved ones who suffered from depression and committed suicide do not wish to speak about it. A common saying, “do not kill the person twice,” means that even if the person is gone, his or her “public face” can still be ruined.

Psychologist Hyong-soo Kim at Chosun University says this public face holds such sway that even in cases where people choose to see a therapist, Koreans will pay in cash to avoid their insurance companies finding out.

Research by psychiatrist Dae-hyun Yoon, at Seoul National University and the Korean Association for Suicide, shows that Koreans are more likely to seek the aid of a priest, psychic, or room salon (where a female bartender or hostess will listen to problems) than a professional therapist. Westernization hasn’t extended to mental health.

At the same time, Korea’s depression rates continue to rise and 80-90 percent of suicides are related to depression.

Refusal of professional treatment, along with wide public acceptance of suicide may be why South Korea was ranked by the Washington Post in 2010 as having the world’s highest suicide rate(in 2014, it ranked third-highest, following Greenland and Lithuania).

This has motivated South Korea’s government to develop intervention programs such as jump-barriers on bridges, glass doors along subway platforms, and 24-hour government-funded suicide hotlines. Though progress has been slow, some Koreans believe the traditional mindset to be flawed.

Currently, the Korean government is increasing funding for mental healthcare and suicide awareness. Online monitoring has led to the closure websites that encourage people to kill themselves. Gramoxone (a pesticide that was a common means of committing suicide) is now banned in Korea. And an expanded state pension system, as well as aid from major corporations, are giving less fortunate individuals the ability to access mental health services they could not previously afford.

Turning traditional ideals on themselves, public service messages now emphasize that the shame of a loved one committing suicide outweighs whatever circumstances led them to consider suicide in the first place. They focus on the idea that honour can be regained by living.

Local therapists know first-hand the values and lifestyles of their clients, and culturally based therapeutic approaches are key to curbing South Korea’s suicide rate. In a country where honour is tantamount to life, solutions must build on tradition, not break it.

– Olivia Jon, Contributing Writer, The Trauma and Mental Health Report

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

This article was originally published on Psychology Today

Laughing at Mental Illness?

December 17, 201510Addiction, Bias, Creativity, Depression, Embarrassment, Featured news, Health, Humor, Laughter, Self-Esteem December, 15

Source: Fractured-Ray on DeviantArt

Whether chuckling at a New Yorker cartoon or an episode of South Park, there is nothing wrong with a bit of laughter. But certain topics are off limits.

Depression, anxiety, psychosis. Is it ever okay to laugh at mental illness?

Many mental health advocates say that mental illness is never a laughing matter. This view was reflected in public outcry after a2013 McDonald’s ad showed an apparently depressed woman with the caption, “You’re Not Alone. Millions of people love the Big Mac.” The helpline under the ad connected callers to the McDonald’s head office. The fast-food giant faced tremendous backlash and quickly pulled the ad, apologizing to those they offended.

Psychologist Howard Samuels, founder of The Hills Treatment Centre in Los Angeles, says that when we laugh at mental health issues, we lessen the seriousness of the condition and dehumanize sufferers. He cites the example of former Toronto Mayor Rob Ford, whose substance abuse made for numerous jokes, ridicule that may have delayed his decision to seek treatment.

But Janine Hobson (name changed), a stand-up comedian for Vancouver’s Stand Up For Mental Health (SMH) and Toronto’s Laughing Like Crazy (LLC) disagrees. To her, the acceptability of finding humour in mental illness depends on who is making the joke and why. Does the person have a mental illness, and is the humour playing down the condition or helping that person connect to others?

According to Janine, a sufferer of bipolar disorder, SMH and LLC help people with mental illness overcome their conditions. As part of the two programs, participants come up with a comedy routine based on their experience with mental illness and the mental health system, performing their sketches in front of live audiences.

David Granirer, the founder of SMH and Janine’s trainer, thinks that comedy gives people with mental illness a powerful voice and helps reduce stigma and discrimination around these issues.

“People with mental illness suffer from the effects of misplaced public perceptions,” states Janine. “What do people think of the mentally ill? They’re dangerous, they’ll fly off the handle and kill you.People are afraid. The other myth is that mental illness is a symptom of a weak personality. When you have mental illness there’s a lot of shame.”

Proponents say that comedy diffuses shame and fights stereotypes. Addressing mental health issues through humour improves communication and creates a meaningful and memorable dialogue about the impact of mental illness on individuals and communities. At the same time, people with severe mental illness performing stand-up comedy—a daunting prospect for most—empowers sufferers and shows that mental illness does not have to be a handicap.

Although not a substitute for treatment, laughter can be a way for people to feel better about themselves and embrace their conditions while educating others.

“It’s a way of giving power and hope back to people like myself who are going through the system and have felt so disempowered over the years, which is so important to keeping someone spirited against the obstacles they face related to their illness,” claims Janine.

Research studies on laughter appear to support these views, showing that humour is related to the development of a positive and realistic self-concept, higher self-esteem and self-worth, and more positive emotional responses to stress. Humour that is good-natured, integrating, and non-hostile is associated with higher self-esteem and competence in interpersonal settings, and more positive feelings.

Janine emphasizes that participants of the SMH and LLC programs focus on their own experiences and make light of their ownproblems (as opposed to belittling or sensationalizing mental illness).

So, can we laugh about the frightening symptoms of schizophrenia? Hard to know, the answer depends on context. At its best, humour creates partnership, hope, and open-mindedness. At its worst, it triggers ridicule and bullying.

The difference is as thin as the line separating comedy and tragedy.

– Veerpal Bambrah, Contributing Writer, The Trauma and Mental Health Report

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

This article was originally published on Psychology Today

Virginity Tests Place Physicians in Quandary

January 29, 201500Embarrassment, Ethics and Morality, Featured news, Gender, Marriage, Parenting, Religion, Trauma January, 15

In October of 2013, the College of Physicians in Quebec, Canada, ordered doctors to stop performing virginity tests on women.

Remarkably, it took a formal directive from a governing agency to stop the degrading practice. Over the 18 months preceding the announcement, there were five reports in Quebec alone of requests for virginity tests. But physicians note that the tests are actually a hidden taboo practice occurring at a very high frequency.

Requests are often made by a woman’s family, seeking to fulfil traditional requirements of providing proof of ‘innocence’ for marriage. Physicians are actively pressured by families to conduct these tests and sign certificates for review by both families, putting doctors in a moral quandary: refusing to perform the test or giving a negative result can dishonour a woman in the eyes of her family, but going along with the procedure represents collusion.

Practiced all over the world, virginity tests are a longstanding tradition. Many African nations uphold the custom, purportedly as a means of controlling AIDS by checking which women are ‘safe’ to marry. But tests do not definitively determine the presence of HIV or AIDS as it is possible for people to become infected through other means—sharing needles or from parents.

And the test is highly subjective. In addition to many women being born with negligible hymens, stressful activities and even tampons can lead to ‘loss of virginity’. Other versions of the test, such as checking for overall laxity of the vagina, are painful and embarrassing.

In 2011, women attending protests in Egypt were rounded up and subjected to virginity tests and other forms of sexual assault and humiliation by police and armed forces. In Indonesia, high-school officials are considering implementing virginity tests as a way of controlling student behaviour and encouraging chastity. In Iraq, virginity tests are regularly ordered by the courts, whereupon husbands can sue their wives and their families for damages and dissolution of marriage. And in India, not only is it common practice to put brides-to-be through the procedure, but even rape victims are subjected, which, if they fail, may mean shunning by families and others.

In Canada, requests for virginity tests have come from parents concerned about daughters’ choices, as well as from educated professionals afraid of disappointing husbands-to-be. While it may seem a relief that the procedure now has been deemed outside the scope of physician practice, pressure remains in some communities, leading many physicians to give out fake ‘virginity certificates,’ to placate families and protect the privacy and dignity of the women in question.

As witnessed by Canadians just over two years ago, traditions like these can escalate with tragic consequences. In June of 2009, Mohammad Shafia, reportedly incensed at his ex-wife’s and daughters’ behaviours, engaged the help of his new wife and son in brutally murdering the four women. Known as honour killing, this practice views women as male property. Similar beliefs hold female chastity and obedience in high regard, with violations of cultural norms being equated with treason, to be cleansed only through death.

In Montreal, Quebec, it was recently discovered that hymenoplasties—surgeries which artificially recreate the hymen so as to cause bleeding during intercourse—have become the second-most popular plastic surgery. Alarmingly, private medical organizations have stepped up and begun offering secret, cash-paid procedures for several thousand dollars to interested parties.

It is hard for physicians to agree on the moral dilemma of virginity testing. One televised discussion shows some doctors stressing the inaccuracy of virginity tests, and how the inherent pain and humiliation associated with them is enough to justify abolishing them entirely. In contrast, Rachel Ross, physician and sexologist, points out that virginity tests can be useful in criminal cases involving children to determine whether sexual abuse took place.

The biggest quandary facing physicians is whether to let virginity tests and hymenoplasties be available to the public. The reasoning behind both has been examined extensively by medical ethicist Marie-Eve Bouthillier, who explains that banning these procedures may seem like the best step to end these women’s pain and humiliation, but it may also subject them to violent retribution or even more demeaning tests conducted by family members or religious leaders.

Conversely, Bouthillier states that “sometimes the virginity certificate will be the ticket for a forced marriage,” meaning that physicians who perform the tests or even give false results may still be condemning these women to a life of suffering.

A difficult choice indeed. Right where the paths of medicine, ethics, and culture collide.

Contributing Writer: Nick Zabara, The Trauma and Mental Health Report

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

Photo Credit:<a href=”https://www.flickr.com/photos/proimos/6869336880/“>Alex E. Proimos</a>

This article was originally published on Psychology Today

Category: Embarrassment