Mental Health | Psychotherapy Toronto

Coronavirus Anxiety Fuels Panic and Racism

March 25, 202000Anger, Anxiety, Bias, Catastrophizing, Coronavirus Disease 2019, Environment, Featured news, Media, Mental Health March, 20

Source: Elchinator at Pixabay, Creative Commons

On December 31, 2019, China alerted the World Health Organization (WHO) about a viral outbreak in the city of Wuhan. By January 30, 2020, the WHO had declared the novel coronavirus (2019-nCoV) a global health emergency.

News outlets around the world have been reporting on the coronavirus by sharing live updates and real-time maps tracking the numbers of infections and deaths around the world. Additionally, experts have been racing to publish open-source articles and share important research. This flurry of negative news, online social media rumors, and increasing government response have brought intensifying anxiety to the public psyche. In fact, anxiety and mass panic have spread quickly.

The Trauma and Mental Health Report (TMHR) spoke with people in the community about their reactions to the coronavirus outbreak. Elisa (name changed for anonymity), a woman in her mid-forties, shared:

“At first I wasn’t worried about what was happening at all. I laughed at people who were anxious and dismissed them. I was not worried during the SARS outbreak. But within a week, all my friends and family were warning me; we all followed the daily headlines. It was keeping me up at night. Though we are halfway around the world from China, the anxiety felt about what happens there is an everyday experience here.”

Amelia (named changed), a retiree, cancelled her travel plans as a result of the virus:

“I had planned a two-week cruise around Asia three months ago. Then the outbreak happened and the virus started to spread around the world. My children were anxious about my safety on the return trip from Hong Kong. I eventually became anxious as well. All the countries I planned to visit had reported infected cases. I ended up cancelling my trip.”

As panic surrounding the coronavirus spread, people began to hoard N95 masks and surgical masks, hoping to protect themselves from the airborne transmission of the virus. John (name changed), a business manager in Hong Kong, explained:

“The panic to buy masks and hoard food was on. Doctors and nurses are on strike, demanding the government close its borders with China. Everyone is on edge, morale at work was seriously affected. It felt like an impending doom was coming.”

Similarly, Farah (name changed), a young mother and student, reported:

“I became so anxious about the news; I couldn’t focus on studying for my test and went online to buy masks for my kids, worrying that they won’t keep it on in school.”

Public health concerns can also exacerbate symptoms in those who struggle with health anxiety. Nadia (name changed), a Russian-Canadian student, said:

“I had nightmares about the coronavirus. I was already a little bit of a germophobe, now I am afraid to touch anything or to go out and see anyone.”

As with previous viral outbreaks, a surge of racism, xenophobia and stigmatizing of Chinese people is also spreading. Time Magazine has called it “The Pandemic of Xenophobia and Scapegoating.” In an interview with CBS News, Priscilla Wald, a professor at Duke University who studies public narratives about disease and epidemics, explains:

“We get a headline like “global health crisis” and everybody everywhere panics, even though in most places, nobody has any reason to panic…Each time we’re in a situation like this we immediately go into panic mode, crisis mode, that has all kinds of problems including stigmatizing people [and] racism…[Seeing] photographs of somebody in a Hazmat suit or [people] wearing face masks, it immediately triggers that panic response.”

Comments on Reddit exemplified the surge of negative comments against Chinese people: “You guys just eat snakes and bats; you deserve the virus.”

Kevin (name changed), described his experiences with racism on Reddit:

“I am Chinese, and because of the coronavirus, I have experienced an increase in racism. Commuters cover their faces when sitting near me, even though I am healthy and not coughing or sneezing. My ethnicity has made me feel like I was part of a threatening and diseased mass.”

To combat mass panic and irrational behaviour, free online resources are available to help people manage their fears. Ali Mattu, a clinical psychologist who specializes in panic and anxiety disorders, posted a video on YouTube to help people cope with anxiety caused by the outbreak. In it, he suggests people limit media consumption, practice healthy habits, read credible sources for information and stick to their regular routine. As well, the University of California, Berkeley’s University Health Services has circulated instructions on how to manage fears and anxiety around coronavirus, including keeping things in perspective and being mindful of our assumptions about others.

by Lotus Huyen Vu, 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

Treatments Now Available For Disordered Gaming

February 14, 202000Addiction, Environment, Featured news, Mental Health, Mindfulness, Parenting, Personality Change, Social Life, Video Game Addiction February, 20

Source: pozaristul at Flickr, Creative Commons, some rights reserved

In June of 2018, The World Health Organization released the 11th version of the International Classification of Diseases (ICD-11). For the first time, Gaming Disorder would be included as a mental health condition that is characterized by physical, social, and psychological impairments due to excessive video gaming.

Like most things, gaming can be healthy in moderation, but some gamers play excessively. Yonah Budd is the Director, Co-Founder and Chief Therapy Officer of The Farm – a private rehab center in Stouffville, Ontario. He has over three decades of experience with youth who are struggling with behaviour- and drug-related addictions. According to Budd, those he considers addicted to gaming often play to escape some form of stress in their lives and do not seek help until they have lost a relationship, a home, a business, or all three.

In an interview with the Trauma and Mental Health Report, Yonah explained that treatment for a gaming disorder utilizes similar steps to a typical drug-use program; one in which the first step for every new client is a complete detox. At The Farm, detoxing begins with a minimum of a 30-day stay without internet access to reduce dysfunctional behaviours. Older clients are typically given a flip phone without data while younger clients are provided with colouring books or building blocks. Being in an outdoor environment also provides a ‘wilderness’ experience in therapy. Being in a natural environment, there are fewer distractions from electronic devices.

Social integration is a very important goal of rehabilitation. People with disordered gaming behavior often experience significant withdrawal from social activities with friends and family. According to Yonah, many teens can become isolated, playing for 8-10 hours per day, sometimes even all night long. It can be especially difficult to withdraw from a routine when playing with online friends. Yonah thinks the rise of online communities has only made it easier to fall into dangerous habits. However, face-to-face social interactions can be beneficial in treating a gaming disorder. Yonah described how social integration helped one of his clients:

“I know a boy now in his 20s. For most of his teenage years he was a gaming junkie… Now as an adult, he can’t spend all his time sitting in front of a computer because in your twenties you don’t do that anymore if you want to be social. Working with him, I said OK, why don’t we look at some board gaming… so now he’s is out 2-3 nights a week playing board games. It’s still gaming, but it’s social gaming…”

Parents and caregivers can play a key role in helping find alternatives to gaming that encourage a healthier lifestyle. Playing video games with a son or daughter can be a great first step to better understand their behavior and build parent-child rapport. As Yonah states:

“Rapport is what it’s all about. Adults have to come to the kids. Dad needs to sit down with Billy and play games with him… If a kid likes racing games, try engaging them in something more social, like go-karting.”

In order to prevent relapse, an important final step is re-integration back into the home environment and the family unit. One program, Venture Academy, places troubled teens from across Canada in “host-home environments.” At the end of the week, each of their teens gets a chance to practice problem-solving skills and daily responsibilities in small, family-sized units. Re-introducing clients to a more familiar setting before returning them home is intended to make it easier to transition from treatment into a normal routine. Chris Madsen, one of the counsellors at Venture Academy, says:

“Change is best retained in the environment in which it is learned. I’ve worked in wilderness programs and there are a lot of positive things about that, so don’t take this as a knock, but a lot of them are recognizing that once the child has “woken up”… teens are relapsing at home because parents are not going to be able to replicate a wilderness program.”

As the issues and technologies continue to evolve, treatment will have to evolve with it and what we learn over the coming decades will determine what methods help most.

– David Remisch, 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

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At Burning Man, Fire Breathing Fuelled by Belonging

January 30, 202000Confidence, Creativity, Environment, Featured news, Mental Health, Synchronicity, Teamwork January, 20

Source: Joris Voeten at Unsplash, Creative Commons

Every year, thousands of fire breathers convene in Black Rock City, Nevada, on Labour Day weekend for an event called Burning Man. People come from far and wide to perform fire acts and to observe the burning of a giant wooden structure. They meet people, practice their art and learn from peers. Hazards notwithstanding, fascination with fire breathing draws thousands to the desert every year.

Fire breathing involves tremendous risk to performers, including severe burns, inhalation of toxic combustion products, and death. Fire breathers are often perceived as “crazy” for putting their lives at risk for the sake of entertainment. So, what drives them?

To be sure, feeling idolized and cheered on draws many to it. In an interview with the Trauma and Mental Health Report, performer Richard Erno describes his experience:

“I get excited more for the crowd and the exchange of energy while I am on stage. I like the look of awe on their faces that say, ‘Wow!’”

But after a while, the thrill wears off, and according to Erno, is no longer a motivating factor: “I was excited more for the crowd in the beginning, but now the act feels routine.”

Once the initial thrill is gone, it is replaced by something much more mundane: a sense of belonging. This was a theme identified in interviews with a number of fire breathers. One of the performers at Burning Man explains:

“The benefit of fire breathing to me is partaking in events such as Burning Man. It was at Burning Man where I had the opportunity to gather with other fire breathers to set the world record for most fire breathers lit in one location. I was an unknown performer invited to hang out and perform with fellow fire breathers. It was as if I had experienced a pilgrimage.”

Despite the dangers, performers believe practicing together and motivating one another makes all their sacrifices worth it. In an interview with the Trauma and Mental Health Report, Tedward LeCouteur, a fire breather and fire marshal trainer said:

“I get to be part of a fire breathing team. There are many of us in a group all doing something we love, pushing each other to be better. We keep each other on our toes, always trying to improve the acts, and push the art to places it has never been.”

This desire to belong is, of course, not unique to fire breathing. In an article published in Psychology Today, Karyn Hall explains that belonging to a special group of people is necessary for optimal mental health:

“A sense of belonging to a greater community improves your motivation, health, and happiness. When you see your connection to others, you know that all people struggle and have difficult times. You are not alone. There is comfort in that knowledge.”

Despite the dangers, fire breathers seem to benefit from being part of this unique community. And, when they join together each year at Burning Man, they are reminded of the reason they entered the profession—not for the money, the fame, or the adrenaline, but for the community that surrounds them.

-David Lipson, 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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Opioid Addiction a Battle Between Parents and the Law

January 16, 202000Addiction, Education, Featured news, Law and Crime, Mental Health, Parenting, Trauma Psychotherapy January, 20

Source: rafabordes at Pixabay, Creative Commons

In 2017, a father from Victoria, British Columbia, pleaded for his 15-year-old daughter to seek rehabilitation for an opioid addiction. He was terrified that by the time she realized she required treatment, it would be too late—a reality for many parents with children battling addictions.

Opioid addiction has reached epidemic levels among youth and adults in North America. In 2016, roughly 64,000 Americans died from this class of substances, which includes illegal drugs like heroin, and prescription drugs such as fentanyl, which constitute the majority of opioid-related deaths. In 2015, approximately 10% of youth ages 15 to 24 were using prescription opiates in Canada.

In Canada, health care is managed provincially. According to lawyer Lisa Feldstein, an expert in the field of children’s mental

Current Canadian laws are deemed highly problematic by parents of drug-addicted children who believe the laws impact their ability to protect their children from danger, leaving many feeling hopeless and afraid. The Trauma and Mental Health Report (TMHR) interviewed numerous parents with drug-addicted children and many believe the very nature of drug addiction impairs an individual’s ability to think rationally and recognize they have a severe problem warranting immediate treatment. This concern was reiterated by the father of the opioid-addicted child from Victoria, British Columbia:

“She’s a child. Her brain is not completely developed. She’s already suffering emotional issues and now the drugs are doing the talking for her. She’s not thinking rationally.”

Parents’ concerns are partially supported by research. According to one study, the reason many individuals with opioid addictions do not seek treatment may be due to dysfunctional neurocircuitry resulting in an impaired ability to recognize their drug addiction.

If it is believed their child lacks mental capacity, parents can obtain an official form, authorized by a physician, allowing their child to be involuntarily admitted to treatment. However, the period of time in which treatment facilities can involuntarily confine children is often short. For example, in British Columbia, Form 4 allows an individual to be involuntarily admitted for 48 hours. To be held longer, a second form must be completed within that 48-hour period, upon which an individual can be held up to 30 days.

In an interview, Brenda Doherty, a parent of a 14-year old opioid-addicted child, expresses the frustration and heartbreak caused by the current mental health system. Doherty was successful in obtaining Form 4, however, her daughter was released from the hospital she was admitted to within one hour of arriving:

“I didn’t even have time to get down there and they discharged her… They let her go and she died a day and a half later.”

While the National Institute on Drug Abuse states that involuntary treatment can be effective, Micheal Vonn, policy director for the British Columbia Civil Liberties Association, argues that involuntary treatment may place children at greater risk once discharged:

“The question then becomes, once they are released, are they actually more inclined or set up for an overdose because they don’t have a structured program to go into to support them in recovery?”

However, according to Families for Addiction Recovery, while voluntary treatment is always preferred, if obtaining consent is not possible, the risks of untreated addiction must be considered, which can include homelessness, juvenile detention and severe medical problems.

In an interview with the TMHR, Kaelan Lanie, a 20-year old from Minnesota who battled an opioid addiction throughout her youth appreciates both sides of the debate:

“Although I think in many cases forced intervention is necessary, I believe the addict has to want the help in order for treatment to actually work, and unfortunately you can’t force someone into wanting to get better.”

When asked what the primary motivating factor was that allowed Lanie to recover from addiction, she said:

“I just had enough. I became willing to do whatever it took to recover and God lined up the right people to believe in me until I could believe in myself.”

Lanie offers advice to parents of drug-addicted children:

“I believe the best thing a parent can do for their child with a drug addiction is to seek help themselves. Talk about things—whether by joining support groups or confiding in friends and family. Addiction is a family disease and everyone must recover from it.”

The balance between respecting children’s autonomy and the duty of a parent to protect their child is complex. However, a case can be made that allowing parents to consent to treatment on behalf of their child, although inadequate to solve the current opioid crisis, can potentially save the lives of opioid-addicted children. For now, all parents can do is support their child as affirmed by the father of the 15-year old from British Columbia:

“I tell her that I love her and to be careful and to take care. And when I get a response, I just know that she’s alive. And that’s all I can ask right now.”

—Julia Martini, Contributing Writer, The Trauma and Mental Health Report

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

-Copyright Robert T. Muller

health law, there is no minimum age for medical consent in most Canadian provinces, including British Columbia. If an opioid-addicted child is deemed to have mental capacity by a physician, they are capable of deciding whether or not they will receive treatment. Exceptions are only granted during medical emergencies in which case a physician decides on the most appropriate action. In contrast, parents in the majority of US states can make medical decisions on behalf of children under the age of 18, with a few US states even allowing parents to send adult children into involuntary treatment.

This article was originally published on Psychology Today

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Could Micro-Dosing Psychedelics Lift Depression?

December 19, 201930Anxiety, Bipolar Disorder, Depression, Featured news, Mental Health, Optimism, Trauma Psychotherapy December, 19

Source: Callie Gibson at Unsplash, Creative Commons

Prescribed medication for mental health issues works for some, but not others. In fact, a study measuring the prevalence of treatment-resistant depression (TRD) in the UK found that 55% of participants met the study’s definition of TRD. Seeking out alternative treatments often becomes the next step for people who do not respond well to medication. Assistant professor David Olson at the University of California, Davis, explains:

“Mind-altering drugs are already being used in the clinic. Ketamine is being prescribed off-label to [treat] depression, and MDMA is entering phase three [the most advanced phase] of clinical trials to treat post-traumatic stress disorder.”

And so, an increasingly popular trend in recent years has been self-administering small doses of psychedelic drugs, such as LSD or magic mushrooms, as an attempt to improve mental health. This is known as micro-dosing. Psychedelic drugs elicit hallucinations, intensified emotions, and changes in sensory feedback and the perception of time when taken in full doses; but, when taken in smaller amounts (approximately one-tenth of a full dose), these drugs are thought by some to be linked to improved mood and energy, reduced anxiety, better focus, and enhanced creativity.

Twenty-seven-year-old Erica Avey, who was interviewed by The Guardian‘s magazine, was experiencing mental health difficulties and decided to try micro-dosing on LSD:

“I started micro-dosing essentially because I was in a really depressed stage of my life. It was for mental health reasons – mood balancing, mood management. It was hard for me to leave my apartment and do normal things…”

By taking approximately one-sixth (about 15 micrograms) of a full dose of LSD every three days, Erika says she was able to go to work, and function normally:

“It lifted me out of a pretty deep depression. I’m still trying to wrap my head around what it has done to me in the long-term. I think it has changed me.”

Not only does Erica consider micro-dosing to have helped her feel less depressed, she says it made her less ruminative and more self-aware:

“I’m able to be more mindful of my emotions. If I’m feeling sad, that’s OK. I don’t obsess anymore. I don’t dwell on it. I don’t get worked up about it.”

And some have tried micro-dosing to help with depression and low mood. Ayelet Waldman, author of A Really Good Day: How Microdosing Made a Mega Difference in My Mood, My Marriage, and My Life, says she had no luck with conventional medications, claiming that micro-dosing on LSD saved her from her intolerable mood storms, changing her life for the better.

The subject of psychedelic micro-dosing remains relatively untouched by researchers. The first study on the micro-dosing of psychedelics was only conducted in 2017 by Thomas Anderson of the University of Toronto, along with York University’s Rotem Petranker, and colleagues. The study looked at over 300 micro-dosers in the Reddit community to examine the effects of micro-dosing on mental health. The authors found that micro-dosers tend to harbour less dysfunctional attitudes, exhibit less negative emotionality, and score higher on measures of wisdom, open-mindedness, and creativity. In an interview with The Trauma and Mental Health Report, author Thomas Anderson spoke about the widespread population of micro-dosers:

“The population was surprisingly well-spread… across all sorts of socioeconomic statuses, and all sorts of different occupations. Micro-dosing was most popular among students… but there was just a huge spread—everything from lawyers, to computer scientists, software developers, professors, construction workers, janitors, and single moms.”

Although most micro-dosers in the study reported improved mood, some experienced negative effects, as Rotem Petranker cautions:

“There were a lot of parallels in reported benefits and drawbacks of micro-dosing. Some people were reporting better focus, and some people were reporting worse focus, or some people were reporting lower anxiety, and some were reporting higher anxiety. And so it’s difficult to parse these results…”

Even with the reported benefits of psychedelic micro-dosing, without randomized placebo-control trials, it is difficult to rule out placebo effects and to draw clear conclusions. These trials are the next step in micro-dosing research.

And then of course, we can’t overlook the fact that these drugs are illegal. For micro-dosers, this was the most significant drawback of micro-dosing. Thomas explains:

“The most commonly reported drawback is that it’s illegal… that also includes trying to buy substances, and not having a steady supply, and not knowing exactly what you’re getting… especially in synthetic cases like LSD. Whenever you’re getting a dose on the black market, you don’t know exactly what you’re getting.”

Experimenting with micro-dosing is not for everyone. There are greater risks associated with micro-dosing for those who have experienced psychosis, have ongoing anxiety, or suffer from more severe mental illnesses such as bipolar disorder. This is true for Allan (name changed) from Reddit, who suffers from bipolar disorder:

“My first truly manic episode was after a mushroom trip. I was diagnosed as bipolar soon after…psychedelics can bring on, sometimes extended, bouts of mania and hypomania.”

Possible long-term effects, such as increased tolerance to a given drug following repeated use, and side effects of psychedelic micro-dosing remain unknown. Rotem explains:

“One of the concerns was that there is an unknown risk effect profile… we don’t know the risks. And the fact that we don’t know is one of the drawbacks of micro-dosing.”

And so, the jury is still out. Rotem adds:

“There could be a lot of individual differences at play, and since setting is really important in full-dose psychedelics, it may also be the case that setting is important in micro-dosing to some degree… we really just need randomized placebo-control trials to figure out what’s what.”

-Emma Bennett, Contributing Writer, The Trauma and Mental Health Report

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

-Copyright Robert T. Muller

This article was originally published on Psychology Today

When a subway passenger dies by suicide, workers suffer too

August 15, 201900Featured news, Mental Health, Post-Traumatic Stress Disorder, Suicide, Trauma, Work August, 19

Source: Lily Banse at Unsplash, Creative Commons

In an article in a Canadian daily, The Globe and Mail, Oliver Moore reported that during 2016, 21 suicide attempts occurred on Toronto’s subway system. In fact, a study published by the Journal of Urban Health considers suicide on subway platforms to be a public health issue.

Subway delays by attempted suicide not only affect passengers, the victims and their families, but drivers as well. Subway workers and drivers who have witnessed a suicide have been reported to have Post-Traumatic Stress Disorder (PTSD). Research suggests that those exposed to human-generated traumatic events have a greater chance of developing PTSD. In an interview with Vice Magazine, psychologist Wilfried Echterhoff discussed the long-lasting psychological trauma workers face when confronted with a death on the worksite:

“Some people have never been confronted with death before…To suddenly be confronted with it in such a violent way can lead to PTSD or a serious depression.”

In an interview with the Trauma and Mental Health Report, Robert (name changed), a retired subway worker with over 30 years of experience, described an incident he faced while working:

“One Saturday afternoon maybe around 11:00 a.m. or 12:00 p.m., I witnessed a lady jump off the subway platform. I needed to go upstairs and tell my supervisor and my supervisor told me that my face was all white. They kicked everyone out and only the police and ambulance were allowed to come in.”

Nik Douglas, a train driver who worked for the Northallerton subway station in the UK, noted in an interview with The Independent:

“When I was on my own I’d burst into tears for no reason, I found sleep hard and I’d have flashbacks during the night and day. I could be in a room full of people with a really good party atmosphere but feel alone and isolated. That’s one of the biggest things I remember, feeling alone… It changed my life instantly from who I was to what I have become. Some people aren’t affected, but two years after it happened I’m still not the same person.”

In deciding what was best for his mental health, Nik took six months off work to deal with his PTSD. Recent studies suggest that in Canada, 6.5% of subway workers have been absent from work due to witnessing suicides while working. Last November, this rate was at its highest with 7.44% of employees absent. Some employees are unable to return to work altogether and opt to receive compensation from their employers.

Nik experienced intrusive distress and feelings of isolation. Kevin, a 39-year-old subway driver expressed his feeling of being responsible for the suicide of a man:

“When he looked at me and our eyes met, time just stood still. It felt like driving your car over railroad tracks, that rumbling feeling you get … I realized then that I just killed somebody.”

In his years of working at the subway, Robert explained the brief protocol subway workers go through once they have witnessed a suicide:

“The subway drivers have to talk to the police after that happens. They always have to stay and give a statement. Then they’re taken off duty for that day. Then they get sent home or to counselling. It depends on what the driver wants to do. It just started recently in the last five or six years. The company asks if the drivers want to speak to someone.”

Effective suicide preventions have been created to decrease the suicide rate in subway stations and increase safety. Subway stations in Tokyo have implemented glass doors that open for passengers to board the subway only once it has arrived in the station. Other preventions put in place are blue lights and mirrors set up to discourage suicide attempts. In London and Paris, these forms of preventions have been effective too.

In addition, intervention programs, including the Gatekeeper Program, exist for those who are feeling suicidal. However, interventions put in place for subway workers who experience suicides are rare. Most workers deal with the effect of these experiences on their own. In Robert’s words:

“If something is going to happen, it’s going to happen. There’s nothing you can do. They don’t tell you this can happen or that can happen. They won’t tell you what can happen when you sign up for this job. They don’t tell you that workers deal with this. They don’t train you how to deal with it. They won’t ever tell you what to expect even when training people.”

Social support is argued to be one of the most powerful factors in recovering from PTSD and is known to decrease risk for depression, foster resilience, and reduce stress in those who have experienced traumatic events. Mindfulness-based stress reduction therapy has shown to reduce stress and increase recovery in those with PTSD.

Lucia Chiara Limanni, 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

Caring for a Loved One with Alzheimer’s Brings Benefits

June 20, 201900Aging, Burnout, Caregiving, Featured news, Memory, Mental Health June, 19

Source: Edwin & Kelly Tofslie at Flickr, Creative Commons

“I’m always in the present. I have to be one step ahead of David. Things go missing all the time in this house—the remote, mail and even the utensils. I’m down to a handful of forks! It would be simple if I could just lock the door to store some important items, but he doesn’t like that.”

Mary (name changed for anonymity) is the primary caregiver for David, her husband of 50 years who is in the final stages of Alzheimer’s disease. For Mary, ‘being in the present’ refers to her constant worry about even the most mundane elements of life that many take for granted.

Recent estimates show that over 5 million Americans are living with Alzheimer’s—a number expected to rise to as high as 16 million by 2050. Currently more than 15 million Americans function as primary caregivers and provide essential, albeit unpaid care for people with Alzheimer’s and other dementia-related illnesses, taking on responsibilities such as bathing, grooming, dressing, feeding, and providing additional daily living assistance. At times, caregivers may even have to manage unexpected and unprovoked acts of violence, paranoia, and inappropriate sexual behaviours. Mary understands this reality all too well. In an interview with the Trauma and Mental Health Report she confirms this additional stress:

“I take David everywhere I go. I’m always scared that he will do something unpredictable, embarrassing and grossly inappropriate.”

This demanding and overwhelming role can take an emotional toll, putting caregivers at risk of becoming socially isolated, exhausted, and suffering from burnout. It is clear that there are drawbacks to being a primary caregiver and Mary has experienced many of them, such as loneliness, guilt, embarrassment, frustration, and even verbal and physical abuse. Mary and many individuals in similar circumstances, continue to do so at the expense of their own wellbeing.

But a growing body of research shows that despite challenges, there are positive aspects associated with providing such care for another person. Studies report that some experience an enhanced sense of meaning in their lives, while others feel a sense of empowerment as they learn how to navigate the health and social systems related to the illness. Caregivers have also been found to frequently reminisce on happy memories, enjoy pleasurable activities, and develop a deeper appreciation for time spent with their loved ones.

When reflecting on their life and their current situation, many of the positive benefits of caregiving resonate with Mary:

“Throughout our marriage, we lived separate lives. At times, I resented David because he would often leave me to go play golf. I felt a distance between us. Now our situation has forced me to spend time with him and in some ways, I’m getting what I longed for. I’ve become closer to family members who have assisted me with David’s care for which I am so grateful. You truly learn who is there for you.”

In addition to gaining a deeper appreciation for her family, Mary acknowledges that she has also grown substantially as an individual:

“I have become more patient and have learned to effectively de-escalate situations. I am confident I can handle a lot more than I could before.”

Speaking with her, it is evident that Mary has come to appreciate the little things in life:

“Despite our daily struggles, there are precious moments; moments when I see glimpses into his soul. Some days when I pick him up from the nursing home, he is eagerly waiting for me by the window. I’m sure he thinks that I’m solely his caregiver. But, I can see his vulnerability and I know that he needs me.”

Many factors appear to influence caregiver resilience: the intensity and context of the provided care, socio-demographics such as age, gender, education, the availability of social and community resources, and the caregiver’s psychological attributes. Though Mary fully acknowledges the struggles and stresses that come with her role caring for David, she remains resilient. And no matter how difficult her situation may get, she stays focused on the gifts this experience has brought her.

-Young Cho, Contributing Writer, The Trauma and Mental Health Report

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

-Copyright Robert T. Muller

This article was originally published on Psychology Today

When Doctors Are At-Risk for Suicide

May 17, 201900Burnout, Depression, Embarrassment, Emotion Regulation, Featured news, Mental Health, Suicide May, 19

Source: Feature: skeeze at Pixabay, Creative Commons

They had known each other well enough in the early days of medical school, when they were students studying well into the night. After graduation, they went their separate ways, each assuming the other was doing well.

“I wanted you to hear it from me,” a colleague sadly said on the phone. Dr. Ranjana Srivastava nearly fell to the pavement when she was told that her long-time friend and colleague—a clinician, wife, and devoted mother—had died by suicide.

Unfortunately, this is not the first that time Dr. Srivastava had to face the suicide of a colleague. In a piece she wrote for The Guardian, Srivastava explains:

“Forced smiles and tough hides abound in the workplace, where always being ‘fine’ is a badge of honour. This is why it can be so difficult to distinguish doctors who will indeed be fine from those who need help.”

Research shows a higher rate of mental health problems among physicians. A 2013 report estimates over 25% of doctors in Australia having at least a minor psychiatric disorder, with 10% reporting suicidal thoughts in the past year. A survey of 2000 U.S. physicians showed that roughly half believed they met criteria for a mental illness in the past, but had not sought treatment. And in Canada, recent research estimates over 26% of Canadian doctors suffer professionally due to poor mental health, with 20% of them reporting they had been depressed in the last 12 months. Overall, roughly 30% of physicians worldwide have depression or symptoms of it, according to an extensive review published in the Journal of the American Medical Association (JAMA).

Why is this the case? The answer isn’t all that clear, but according to physician and social worker Katharine Gold and colleagues, stigma is to blame. Their research looked at survey responses of over 2000 female physicians, and it showed that stigma attached to mental illness is greater among medical trainees and physicians than in the general population. According to one respondent:

“I have been discriminated against in a department after disclosing my history of well-treated depression to my department chief.”

And this is not an isolated incident. Studies show that 50% of doctors are less likely to work with a colleague who has a history of depression or anxiety disorder, with four in ten admitting to thinking less of such a colleague. And throughout the years, healthcare organizations have favoured a punitive approach when addressing the issue of physician mental illness, rather than a supportive one. So disclosing mental health issues by a medical doctor can pose a real threat to licensing, career, and reputation, leading to reluctance to seek help.

In an interview with the Trauma & Mental Health Report, medical student Jamie Katuna explains the predicament physicians face:

“Getting care could mean problems for doctors. If they seek help for mental health issues and if someone decides they are ‘unstable’ and shouldn’t be seeing patients, that physician is out of a job and would have a really hard time finding another one. So instead, doctors suffer in silence.”

When deteriorating mental health makes it difficult to work, many physicians ignore their symptoms and continue to work anyway, often self-medicating with drugs or alcohol to avoid the perceived embarrassment of having a psychological disorder.

Steps are being taken to bring awareness. Many universities and medical organizations are starting conversations about physician wellness and stigma reduction. Physicians and medical students who have lived through suicide attempts, depression, and other mental health issues are standing up for themselves and each other. Likewise, organizations such as the American Foundation for Suicide Prevention and the American Medical Association have recommended reforming medical licensing questions to make it clear that physicians may get help without fear of negative consequences. Despite the growing support, Thomas Schwenk of the University of Nevada School of Medicine noted that change isn’t happening fast enough:

“A lot of [conversations about mental health stigma are] very difficult and very slow to happen, and unfortunately tragic incidents like the two suicides in Quebec and other suicides across the country are still occurring because it’s taking time to change that culture.”

There are some resources available. In Canada, organizations like Physician Health Program and the Canadian Medical Association provide a range of direct services for physicians and medical students at risk of, or suffering from, substance use, psychiatric disorders, or occupational stress. The interventions offered can include awareness workshops, referral to treatment, and monitoring, all while maintaining confidentiality. Also, online resources such as ePhysicianHealth and Combating Stigma are available.

Most solutions exist at a personal or program level, but the problems are pervasive and affect the entire structure of healthcare education. According to Katuna:

“The culture of medicine should undergo amazing and radical transformations. We need to redesign how we implement medical education.”

Systematic problems require systematic solutions and until then, medical professionals remain at risk.

— Ilia Azari, Contributing Writer, The Trauma and Mental Health Report.

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

This article was originally published on Psychology Today

Misdiagnosis All Too Common for Women with Autism

May 3, 201900ADHD, Autism, Cognition, Featured news, Gender, Mental Health, Wisdom May, 19

Source: Ryan McGuire at Gratisography, Creative Commons

After twenty-eight years of being “dragged through the system,” Emily Swiatek was finally diagnosed with Asperger’s, a branch of Autism Spectrum Disorder (ASD). For Emily, receiving the diagnosis felt like “coming home to a version of yourself that you have been denied of.”

Research shows that Autism Spectrum Disorder is more prevalent in males than females by a ratio of three to one. But there is increasing evidence that this gender difference may be slimmer than we think, and that autism symptoms in women and girls are frequently overlooked and misdiagnosed.

In an interview with the Trauma and Mental Health Report, Emily explains her frustration with being shuffled from one specialist to another for years, without receiving an adequate explanation for her symptoms:

“I’ve been through quite a long journey, being given about 10 mental health diagnoses along the way. It was getting to that point where it felt like I was caught in the middle of a guessing game. I kept coming up against the same response of ‘we don’t really understand let’s keep throwing the labels and see what sticks’.”

The National Autistic Society survey conducted in the United Kingdom found that compared to males, women and girls are more likely to be misdiagnosed, with 42% of females diagnosed with a mental disorder other than autism when being assessed, as opposed to 30% of males.

Emily’s experience is not unique. Hannah Belcher, who was diagnosed with Asperger’s Syndrome at 23, shares her experience:

“Throughout my life, I’ve been diagnosed with Anxiety, Depression, Bipolar, traits of Borderline Personality Disorder, and ADHD. Some correct and comorbid, some incorrect and misdiagnosed.”

There is no clear explanation as to why women with autism are often misdiagnosed. Child psychiatrist Meng-Chuan Lai, a clinician-scientist at the Centre for Addiction and Mental Health says that while there is a range of different reasons why women receive a diagnosis of ASD later in life, one possibility is that autism characteristics aren’t so evident in females:

“Girls and women may be more able to master ‘camouflaging’, so ‘typical’ autistic characteristics could be masked when they learn social skills.”

Lai describes this as the ability to learn neurotypical social behaviours such as eye contact, gestures, holding conversations, and the utilization of social scripts. These neurotypical behaviours represent those who are not on the autism spectrum in contrast to the neurodiverse behaviours which refer to differently wired brains and cognitive styles attributed to those on the autism spectrum.

In the foreword for Safety Skills for Asperger Women by Liane Holliday Willey, Tony Atwood describes this “camouflaging” phenomenon, reporting that young girls mask the symptoms of autism by socializing and interacting with their peers, causing a delay in diagnosis.

Both Hannah and Emily attribute mimicking socialization patterns as an important factor. Emily explains:

“I’m not a part of that traditional profile of autism… It never even occurred to anyone who was assessing me that somebody who looks like me, somebody who presents like me, could be autistic because I’m smiley, I’m eloquent, I can probably make eye contact if I have to, even though I don’t like it. I’m a very strong mimicker and that masking and mimicking profile is true for me. I think I very much fit that ‘well behaved little girl’ image—very intelligent, liked reading, very quiet, maybe they’d say I was shy.”

Lai notes that another possible reason for the misdiagnosis is that women and girls tend to have restricted and repetitive behaviours that are less likely to be recognized:

“The issue is that some of these narrow interests of autism in males, if you only look at the content, are more traditionally male-typical such as trains, dinosaurs, trucks, and they are most easily recognized by clinicians because of our own stereotypes of autism. For girls, their restricted and repetitive behaviours might not be captured by standardized instruments as they are deemed as less noticeable.”

Recent research has touched on the idea of bias in the way autism is diagnosed. One study showed that girls are more likely to be diagnosed if they had an additional intellectual disability or behavioural issues. However, without these, many women are receiving incorrect diagnoses, or none at all. Hannah agrees:

“Sometimes you might feel like you don’t fit in anywhere, everything everyone thinks about autism is male biased. However, as slow and painful as the journey is, there is always a light at the end of the tunnel. It takes us a little bit longer to get to it, but it is worth the journey.

In a study looking at sex differences between children with autism, researchers recommend new strategies for improving autism recognition in females. In fact, Australia is the first country to form new national guidelines to help increase early diagnosis of women with autism. Considerations of social camouflaging, anxiety, sensory overload, and depression are being included in these new guidelines.

If these guidelines are implemented, it will be possible to decrease the number of misdiagnoses in women and girls who have autism, leading to less frustration for these women and more time to learn how to manage their diagnosis. Emily says that since she received her diagnosis, her life has changed for the better:

“It was instant relief the minute I got my diagnosis. It just made sense. It was right. It was instantaneous the difference it made. My general well-being just went up and up and up, and is still on an upward trajectory.”

-Lucia Chiara Limanni, 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

Jurors Are Left Traumatized by Some Court Cases

April 19, 201900Decision-Making, Dopamine, Empathy, Featured news, Law and Crime, Mental Health, Post-Traumatic Stress Disorder, Stress, Trauma April, 19

Source: Marica Villeneuve, Trauma and Mental Health Report artist, used with permission

On November 7, 2016, the Ministry of the Attorney General of Ontario reached a settlement with a juror diagnosed with vicarious post-traumatic stress disorder. The juror served on the trial of eight-year-old Tori Stafford’s killer.

The woman, who cannot be named due to a publication ban protecting the identity of jurors in this case, received the diagnosis months after performing her civic duty. Four years ago, she was one of 12 jurors in the trial of Michael Rafferty, the man charged and convicted of kidnapping, sexually assaulting, and murdering Stafford.

While sitting on the jury during the two-month trial, the woman visited scenes of rape, saw photographic evidence of the crime, and heard eyewitness testimony from Rafferty’s girlfriend and accomplice, Terri-Lynne McClintic.

In a submission to the Ontario Court of Appeal, the juror said that, almost immediately after the trial, she lashed out at her children, suffered from depression, had flashbacks to disturbing pieces of evidence, and experienced short-term memory loss and difficulties with concentration.

Over the course of a criminal trial, jurors are often exposed to disturbing graphic evidence. And while jury members are instructed to remain unbiased and evenhanded, the process can take a toll on their mental health.

Beyond the traumatizing effects of graphic evidence, the weight of the task itself can be harmful to jurors’ wellbeing. The high-stakes decision that members have been tasked with, which includes determining the fate of someone’s life, can be psychologically taxing. This pattern of stress and anxiety is frequently observed in other high-pressure jobs that involve exposure to traumatic information and heavy responsibilities, such as social work.

Patrick Baillie, a psychologist with Alberta Health Services, and former Chair of the Mental Health Commission of Canada, says that jury members are often not mentally prepared to sit through a criminal trial:

“These are twelve citizens who don’t typically have any involvement with the system, which is why we want them to serve as jurors, being given this extraordinary task with not a whole lot of mental support.”

In addition to the responsibility of remaining impartial, jurors are not allowed to share any details related to their deliberations. To protect the integrity of the trial, members are prohibited from discussing their personal views on the evidence, witnesses, or trial process, to ensure confidential information cannot be related back to discussions that took place in the jury room. Baillie explains:

“It is illegal to disclose the deliberation of a jury to anybody. So, [you] can’t tell a spouse and family and friends… people in [your] usual support system and the mental health professionals that [you] may want to come in contact with down the road. We need to make sure that jurors are not identified and to make sure the process is pure as it can be.”

Under these circumstances, jury members are left to process the psychological and emotional effects of the trial on their own.

Barbara Legate, the lawyer representing the juror from Stafford’s case, argues:

“We ask jurors to sit through days, weeks, and sometimes months of testimony and sometimes that testimony is very, very difficult, and we ask them to keep it to themselves, not discuss it with people outside.”

Until recently, Ontario judges were responsible for deciding whether jurors should be offered counseling at the end of a trial. Jurors would then either be connected with counselors provided by the Ministry of the Attorney General or would pursue counseling on their own.

Starting in January 2017, however, Ontario initiates a new program to provide free and accessible counseling services to anyone serving on a jury. The Ontario Attorney General Yasir Naqvi says the Juror Support Program will be available for anyone serving in a criminal or civil trial, or an inquest.

Jurors will be provided with information on the program at the beginning of a trial, and then again as it finishes. They will call a designated phone number, speak to a specialist who does an assessment, and have counseling made available to them. A third party will provide and cover the costs of the counseling services, but the government still determines who that third party will be. Naqui says:

“Jurors in difficult trials do face evidence that could be quite horrific, and we’ve heard those stories. It’s only appropriate that we provide appropriate services.”

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

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

-Copyright Robert T. Muller

This article was originally published on Psychology Today

Category: Mental Health