Category: Health

Robert T Muller - Toronto Psychologist

Parkinson’s Takes its Toll on Family Caregivers

20Caregiving, Family Dynamics, Featured news, Health, Neuroscience, Parenting, Stress January, 18
Source: Lesia Szyca, Trauma and Mental Health Report Artist, used with permission

Her hands and legs trembled, she could no longer drive. Cognitively, she declined. Her balance was affected, and she often fell. My grandmother Anna (name changed) had Parkinson’s Disease. It took over her life.

As a vibrant and independent woman, Anna had always been eager to help her family. Then, as the disease progressed, roles began to shift, and younger family members had to care for her.

Anna battled Parkinson’s Disease (PD) for more than 15 years. A degenerative neurocognitive condition, it is caused by a gradual loss of dopamine producing cells in the brain that worsens over time leading to tremors, cognitive impairment, and emotional changes.

To date, there is no cure, so a combination of medication and therapy is the only treatment. Anna battled this debilitating illness with no chance of recovery.

As she declined, so did her capacity to be self-sufficient. Her motor abilities drastically decreased, and her memory continued to diminish. She required supervision the majority of the day, and was unable to perform her favorite activities, such as baking, making crafts, sewing, and gardening.

Before Anna was admitted to a long-term facility in 2015, caring for her became a full-time job shared by my mother, my sisters, and grandfather. For my mother Charlotte (name changed), seeing her mother’s deterioration was particularly difficult. Unexpectedly shouldering the role of primary caregiver took a toll:

“At times on my own, I would go in the shower and cry. At other times too, the circumstances made me short and impatient with people. I would be intolerant and lose my temper due to the frustration.”

A study by Laurence Solberg and colleagues examined the emotional and mental health of adult children who are primary caregivers to ill parents. In administering a survey to identify stress levels, the researchers found that caregivers had heightened levels of negative feelings, such as anxiety, while caring for a parent. They found that being a caregiver of an elderly, sick parent adversely affected personal health. However, caregivers balancing the needs of an ill parent with those of their own children did not experience elevated stress compared to individuals without children.

But my own mother’s experience was different. She found it demanding to balance caring for an ill parent and caring for her own children.

“If you only have to balance an elderly parent and a job, it’s much easier than if you also have a family. With children, there’s additional responsibility. Anna required some priority, but I couldn’t lose focus on my children.”

When researchers Caroline Kenny and colleagues examined the experiences of family caregivers, many expressed distress over feeling unprepared for the role. My mother felt the same:

“We didn’t know how to properly care for Anna. We didn’t know how to lift her correctly, or how to deal with her frustration. On top of having the responsibility of caring for her, we had the added stress of not knowing how to handle her properly.”

And finding time for herself was not easy for my mother either. Solberg’s research supports this predicament: three quarters of caregivers reported decreased time for personal hobbies and interests. Charlotte said:

“I do think these responsibilities cause you to neglect your usual pastimes. I went from work to Anna’s home to my home. There wasn’t time for myself.”

In a study by Vasiliki Orgeta and colleagues, published in the International Psychogeriatrics Journal, the authors reported on the importance of social support for coping with the strain of becoming a caregiver.

For me, it was painful to see my grandmother’s decline alongside my own mother’s struggle to care for her. But consistent with Orgeta’s findings, I’ve found that relying on friends and family, and my social support system, has helped alleviate the anxiety of seeing my family in distress.

No one’s experience is the same; people cope in their own ways. For my mother, the situation has been heartbreaking:

“Seeing a person who is loving and vibrant, such a nurturing mother, become a person who is not nurturing anymore, not strong, whether emotionally or physically, is agonizing. It’s a part of life, but it’s hard to accept.”

–Alyssa Carvajal, 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

vb10-_-feature-1-470x260.jpg

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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Online Programs Confront Suicide in Indigenous Communities

00Depression, Featured news, Health, Resilience, Suicide, Therapy December, 17

Source: Nicole Mason at unsplash, Creative Commons

In 2016, a wave of suicides occurred in Canada’s indigenous populations. Communities in northern Saskatchewan, in particular, witnessed several youth suicides. In October of that year, five girls between 10 and 14 died by suicide in the span of a few weeks. The situation intensified when news broke later that month that a 13-year-old girl was the latest to take her life: a total of six young girls in the province.

Indigenous communities have a long and painful history of mental health issues. Persistent poverty, discrimination, and systemic racism have been cited as key factors in the growing mental health crisis these people face today. Indigenous communities are found in remote, less populated areas, making it difficult for them to get adequate care.

Suicide is the leading cause of death for indigenous peoples—indigenous youth being an acutely vulnerable population. Unsurprisingly, there has been a public outcry for intervention. To reach these remote areas, both activists and researchers are turning to technology to alleviate the growing suicide epidemic.

The We Matter Campaign, an initiative by brother-sister duo Kelvin and Tunchai Redvers, began in October 2016. The campaign consists of videos from members of the indigenous community sharing personal stories of survival and hope. The Redvers’ website hosts a variety of work from indigenous youth—visual art and poetry, in addition to the videos, which are the main focus. Individuals with diverse experiences have shared their stories, from high school students to residential school survivors to members of parliament.

One especially moving story comes from comedian Don Burnstick, who discloses:

“I ended up on a chair with a rope around my neck, and I was going to hang myself. …I imagine if I would have done that, I would have ended up another statistic; a cross on the ground in my res. None of this life would have happened for me. I was very grateful that I got off that chair, took the rope off and looked at suicide and said ‘I’m not going to do it. I don’t care how much pain I’m in. I’m not going to do it. You’re not going to get me.’”

By hosting a multi-media campaign on platforms like Facebook and Twitter, as well as their own website, the Redvers harness technology and social media to reach otherwise isolated populations.

Kelvin and Tunchai Redvers spoke to the Trauma and Mental Health Report about their initiative. When asked how it started, Kelvin emphasizes the role of the internet: “It seemed like something so simple, yet we hadn’t seen anyone do it yet… 3 a.m. is when life seems so bleak and you feel most alone. Since our campaign is online and available at all hours, it could really help during those dark moments.”

Tunchai further highlights the important role technology plays in their approach: “Our campaign is online, and it lives online—to all remote corners, to those who might not reach out for help. It’s less overwhelming that way, less intimidating.”

Researchers, too, are harnessing the power of technology to help indigenous youth populations. Sally Merry and colleagues at Auckland University have developed a video game called SPARX (Smart, Positive, Active, Realistic, X-Factor thoughts). SPARX is a fantasy role-playing game designed to teach coping skills based on the principles of cognitive behavioural therapy. SPARX teaches five behaviours to help young people address stress or depression: problem solving; being active; dealing with negative thoughts; improving social skills; and learning relaxation techniques.

Anecdotal findings in Auckland show that adolescents using SPARX report feeling happy that their peers don’t know they are depressed, and that they can deal with their mental health concerns on their own. That same study found youth reporting decreased feelings of hopelessness and better emotion regulation. One user explains, “It gives you the courage to sort out your problems, face your problems, and may even enable you to take another step and talk to someone.”

SPARX has been used to treat depressed youth in a variety of cultural contexts, including indigenous youth. After successful results with the New Zealand Māori population, the approach is being tried in Canada. Given that individuals of the Inuit community in Nunavut are 11 times more likely than the national average to commit suicide, researchers from York University are working to adapt SPARX for the Inuit context (SPARX-N).

This technology is enabling new routes to helping marginalized, indigenous populations that live in inaccessible areas. Although tangible outcomes remain to be seen, technology-based solutions offer hope toward helping heal a long history of trauma. Above all, the founders of the We Matter Campaign emphasize the strength and resilience of indigenous communities. Tunchai says: “There are a lot of issues out there, but also so much creativity, love, and hope.”

–Fernanda de la Mora, 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

fd-_-article-1-_-feature-1-470x260.jpg

Online Programs Confront Suicide in Indigenous Communities

30Depression, Featured news, Health, Resilience, Suicide, Therapy December, 17

Source: Nicole Mason at unsplash, Creative Commons

In 2016, a wave of suicides occurred in Canada’s indigenous populations. Communities in northern Saskatchewan particularly witnessed several youth suicides. In October of that year, five girls between 10 and 14 died by suicide in the span of a few weeks. The situation intensified when news broke later that month that a 13-year-old girl was the latest to take her life: a total of six young girls in the province.

Indigenous communities have a long and painful history of mental health issues. Persistent poverty, discrimination, and systemic racism have been cited as key factors in the growing mental health crisis these people face today. Indigenous communities are found in remote, less populated areas, making it difficult for them to get adequate care.

Suicide is the leading cause of death for indigenous peoples—indigenous youth being an acutely vulnerable population. Unsurprisingly, there has been a public outcry for intervention. To reach these remote areas, both activists and researchers are turning to technology to alleviate the growing suicide epidemic.

The We Matter Campaign, an initiative by brother-sister duo Kelvin and Tunchai Redvers, began in October 2016. The campaign consists of videos from members of the indigenous community sharing personal stories of survival and hope. The Redvers’ website hosts a variety of work from indigenous youth—visual art and poetry, in addition to the videos, which are the main focus. Individuals with diverse experiences have shared their stories, from high school students, to residential school survivors, to members of parliament.

One especially moving story comes from comedian Don Burnstick, who discloses:

“I ended up on a chair with a rope around my neck, and I was going to hang myself. …I imagine if I would have done that, I would have ended up another statistic; a cross on the ground in my res. None of this life would have happened for me. I was very grateful that I got off that chair, took the rope off and looked at suicide and said ‘I’m not going to do it. I don’t care how much pain I’m in. I’m not going to do it. You’re not going to get me.’”

By hosting a multi-media campaign on platforms like Facebook and Twitter, as well as their own website, the Redvers harness technology and social media to reach otherwise isolated populations.

Kelvin and Tunchai Redvers spoke to the Trauma and Mental Health Report about their initiative. When asked how it started, Kelvin emphasizes the role of the internet:

“It seemed like something so simple, yet we hadn’t seen anyone do it yet. 3AM is when life seems so bleak and you feel most alone. Since our campaign is online and available at all hours, it could really help during those dark moments.”

Tunchai further highlights the important role technology plays in their approach:

“Our campaign is online, and it lives online—to all remote corners, to those who might not reach out for help. It’s less overwhelming that way, less intimidating.”

Researchers, too, are harnessing the power of technology to help indigenous youth populations. Sally Merry and colleagues at Auckland University have developed a video game called SPARX (Smart, Positive, Active, Realistic, X-Factor thoughts). Referred to as the first “scientifically-proven ‘gamified’ online therapy for depressed people,”SPARX is a fantasy role-playing game designed to teach coping skills based on the principles of cognitive behavioural therapy. SPARX teaches five behaviours to help young people address stress or depression: problem solving; being active; dealing with negative thoughts; improving social skills; and learning relaxation techniques.

Anecdotal findings of SPARX in Auckland show that adolescents using it report feeling happy that their peers don’t know they are depressed, and that they can deal with their mental health concerns on their own. That same study found youth reporting decreased feelings of hopelessness and better emotion regulation. One user explains:

“It gives you the courage to sort out your problems, face your problems, and may even enable you to take another step and talk to someone.”

SPARX has been used to treat depressed youth in a variety of cultural contexts, including indigenous youth. After successful results with the New Zealand Māori population, the approach is being tried in Canada. Given that individuals of the Inuit community in Nunavut are 11 times more likely than the national average to commit suicide, researchers from York University are working to adapt SPARX for the Inuit context (SPARX-N).

This technology is enabling new routes to helping marginalized, indigenous populations that live in inaccessible areas. Although tangible outcomes remain to be seen, technology-based solutions offer hope toward helping heal a long history of trauma. Above all, the founders of the We Matter Campaign emphasize the strength and resilience of indigenous communities. Tunchai says:

“There are a lot of issues out there, but also so much creativity, love, and hope.”

–Fernanda de la Mora, 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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Talking About Death May Prevent End-Of-Life Suffering

00Anxiety, Decision-Making, Featured news, Grief, Health, Psychopathy December, 17
Source: Marica Villeneuve, Trauma and Mental Health Report artist, used with permission

Death comes unexpectedly. As City University of New York professor Massimo Pigliuccionce said, “You can evade taxes. But so far, you can’t evade death.” Just what is it, though, that we are trying to evade?

“We don’t know how or when we will die – even as we are actually dying,” wrote Joan Halifax, medical anthropologist and Zen teacher. “Death, in all its aspects, is a mystery.”

But we can talk. In conversation, we are able to clarify our wishes for end-of-life care, express our fear of the unknown, and grieve the loss of a loved one.

The “Death Café”, or “café mortel”, is a movement in which strangers meet to talk about death over tea and cake. The first “café mortel” was hosted in 2004 by Swiss sociologist and anthropologist Bernard Crettaz. In 2011, the movement migrated to the UK and took on the name “Death Café”. Their website states:

“Our aim is to increase awareness of death to help people make the most of their (finite) lives.”

In an article for Aeon, freelance essayist Clare Davies described the kinds of topics explored at Death Café:

“The guests take turns to voice their thoughts and feelings across a wide range of subjects. How does it feel to lose a parent? What is existence? What matters most to us in life? The point is to talk. What is death like? What exactly are we afraid of? To what degree do our ideas on death influence how we live?”

But death isn’t an easy topic… even some doctors avoid it.

A 2015 study led by Vyjeyanthi Periyakoli at the Stanford University School of Medicine found that 86 percent of 1040 doctors said that they find it “very challenging” to talk to patients about death.

Yet, conversations that explore patient values are essential to end-of-life care. Many prefer to forgo aggressive treatments that are unlikely to prolong life, or improve its quality. Conversations ensure that patients are protected from unwanted treatments and excessive rescue measures that may lead to distress.

End-of-life distress can take many forms. Medications and surgeries often leave the body frail and vulnerable to other illnesses, or dependent on a ventilator or intravenous nutrition.

In a 2010 New Yorker article entitled “Letting Go”, medical doctor and public health researcher Atul Gawande wrote:

“Spending one’s final days in an intensive care unit because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place.”

End-of-life decisions can be stressful for both the patient and doctor. But talking about them does help.

In the New Yorker article, Gawande describes a 2008 Coping with Cancer study in which only one-third of patients reported talking with their doctors about goals for end-of-life care, even though they were, on average, four months from death. Those who did have end-of-life conversations were significantly less likely to undergo cardiopulmonary resuscitation, be put on a ventilator, or end up in an intensive care unit. Gawande wrote:

“These patients suffered less, were physically more capable, and were better able, for a longer period, to interact with others. In other words, people who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation, and to spare their family anguish.”

Audrey Pellicano hosts the New York Death Café, and works as a grief counsellor. She told the New York Times:

“Death and grief are topics avoided at all costs in our society. If we talk about them, maybe we won’t fear them as much.”

This sentiment is echoed by palliative care specialist Susan Block, who was interviewed by Gawande for the New Yorker article. Regarding end-of-life conversations, she said:

“A large part of the task is helping people negotiate the overwhelming anxiety—anxiety about death, anxiety about suffering, anxiety about loved ones, anxiety about finances.”

Fear surrounding life’s end is immense and varied. But death comes regardless. Perhaps what is needed is an ideological shift, supported by movements like the Death Café, which provides opportunities for people to discuss death from a safe distance. By facing death, a greater appreciation of life’s preciousness may emerge, clarifying what we want most from both living and dying.

–Rebecca Abavi, 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

ra_feature-1-marica-_-cropped-470x260.jpg

Talking about Death May Prevent End-Of-Life Suffering

80Anxiety, Decision-Making, Featured news, Grief, Health, Psychopathy December, 17
Source: Marica Villeneuve, Trauma and Mental Health Report artist, used with permission

Death comes unexpectedly. As City University of New York professor Massimo Pigliuccionce said, “You can evade taxes. But so far, you can’t evade death.” Just what is it, though, that we are trying to evade?

“We don’t know how or when we will die – even as we are actually dying,” wrote Joan Halifax, medical anthropologist and Zen teacher. “Death, in all its aspects, is a mystery.”

But we can talk. In conversation, we are able to clarify our wishes for end-of-life care, express our fear of the unknown, and grieve the loss of a loved one.

The “Death Café”, or “café mortel”, is a movement in which strangers meet to talk about death over tea and cake. The first “café mortel” was hosted in 2004 by Swiss sociologist and anthropologist Bernard Crettaz. In 2011, the movement migrated to the UK and took on the name “Death Café”. Their website states:

“Our aim is to increase awareness of death to help people make the most of their (finite) lives.”

In an article for Aeon magazine, freelance essayist Clare Davies described the kinds of topics explored at Death Café:

“The guests take turns to voice their thoughts and feelings across a wide range of subjects. How does it feel to lose a parent? What is existence? What matters most to us in life? The point is to talk. What is death like? What exactly are we afraid of? To what degree do our ideas on death influence how we live?”

But death isn’t an easy topic… even some doctors avoid it.

A 2015 study led by Vyjeyanthi Periyakoli at the Stanford University School of Medicine found that 86% of 1040 doctors said that they find it “very challenging” to talk to patients about death.

Yet, conversations that explore patient values are essential to end-of-life care. Many prefer to forgo aggressive treatments that are unlikely to prolong life, or improve its quality. Conversations ensure that patients are protected from unwanted treatments and excessive rescue measures that may lead to distress.

End-of-life distress can take many forms. Medications and surgeries often leave the body frail and vulnerable to other illnesses, or dependent on a ventilator or intravenous nutrition.

In a 2010 New Yorker article entitled “Letting Go”, medical doctor and public health researcher Atul Gawande wrote:

“Spending one’s final days in an intensive care unit because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place.”

End-of-life decisions can be stressful for both the patient and doctor. But talking about them does help.

In the New Yorker article, Gawande describes a 2008 Coping with Cancer study in which only one third of patients reported talking with their doctors about goals for end-of-life care, even though they were, on average, four months from death. Those who did have end-of-life conversations were significantly less likely to undergo cardiopulmonary resuscitation, be put on a ventilator, or end up in an intensive care unit. Gawande wrote:

“These patients suffered less, were physically more capable, and were better able, for a longer period, to interact with others. In other words, people who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation, and to spare their family anguish.”

Audrey Pellicano hosts the New York Death Café, and works as a grief counsellor. She told the New York Times:

“Death and grief are topics avoided at all costs in our society. If we talk about them, maybe we won’t fear them as much.”

This sentiment is echoed by palliative care specialist Susan Block, who was interviewed by Gawande for the New Yorker article. Regarding end-of-life conversations, she said:

“A large part of the task is helping people negotiate the overwhelming anxiety—anxiety about death, anxiety about suffering, anxiety about loved ones, anxiety about finances.”

Fear surrounding life’s end is immense and varied. But death comes regardless. Perhaps what is needed is an ideological shift, supported by movements like the Death Café, which provides opportunities for people to discuss death from a safe distance. By facing death, a greater appreciation of life’s preciousness may emerge, clarifying what we want most from both living and dying.

–Rebecca Abavi, 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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Climate Change Affecting Farmer’s Mental Health

60Depression, Environment, Featured news, Health, Suicide, Work December, 17

Source: CIAT at flickr, Creative Commons

The cutoff for irreversible climate change has long been accepted as two or more degrees in global temperature compared to pre-industrial records. Reports show that, in early March 2016, this cutoff was crossed for the first time in recorded history.

January and February of 2016 broke all previous monthly records for high temperatures. Accompanying this trend are regular reports of melting ice caps and changes to animal migratory patterns. But the link between climate change and mental health is less visible.

One effect has been observed in farmers who are closely connected to the land. For some, environmental problems stem from insufficient water supply. For others, too much rainfall is a detriment to crop growth. Not surprisingly, farmers are anxious.

Matthew Russell is an Iowan farmer whose family has tended to their land for five generations. In an interview with Medical Daily, he recounts the physical and psychological toll brought on by extreme climate conditions:

“Psychologically, in the last few years, there’s a lot of anxiety that I don’t remember having 10 years ago. In the last three or four years, there’s this tremendous anxiety around the weather because windows of time for quality crop growth are very narrow.”

Russell explains that this narrow window is due to increasing levels of rain, which leave his land muddy and wet, decreasing crop quality.

Aside from droughts and flooding, extreme temperatures compound the problem, as do weeds, pests, and fungi that thrive better as a result of warmer temperatures and increased carbon dioxide levels.

For those like Russell who have farmed throughout their lives, the idea of uprooting and relocating or finding a new profession seems daunting. With the continuing effects of climate change, this threat may soon become reality.

Anxiety is not the only mental-health concern influenced by climate change. A reportfrom the US National Library of Medicine states:

“An association has been found between crop failures due to unexpected droughts and suicide attempts in the farmers. Failure of crop can lead to economic hardships. When dependent on low precipitation situations, the farmer might not be able to sustain the expenses of the family and may become a victim of the debt trap to meet the expenses.”

Although the report focuses on droughts in Australian and Indian populations, these experiences are echoed elsewhere, like in California. Drought there has contributed to failed crops for farmers, as well as increased food prices for consumers in North America. A 2012 report showed that the economic hardship associated with these problems has increased the risk of suicide in American farmers.

A study on suicide by Ryan Sturgeon at the University of Calgary examined the content of calls to a rural stress line from farmers in Manitoba, Canada. He found that farmers may not be using the mental health resources open to them:

“Multiple factors may negatively impact farmers’ help-seeking behaviour, including greater isolation due to a growing distance between farms, increased competition and less cooperation among farmers because of the changing global economy, and fragmentation of existing rural communities as more people are moving off farms and into urban areas.”

Problems brought on by climate change are exacerbated in vulnerable rural communities populated by farmers. But as a worldwide phenomenon, climate change is likely to affect mental health globally.

–Andrei Nistor, 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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Climate Change Affecting Farmers' Mental Health

00Depression, Environment, Featured news, Health, Suicide, Work December, 17

Source: CIAT at flickr, Creative Commons

The cutoff for irreversible climate change has long been accepted as two or more degrees in global temperature compared to pre-industrial records. Reports show that, in early March 2016, this cutoff was crossed for the first time in recorded history.

January and February of 2016 broke all previous monthly records for high temperatures. Accompanying this trend are regular reports of melting ice caps and changes to animal migratory patterns. But the link between climate change and mental health is less visible.

One effect has been observed in farmers who are closely connected to the land. For some, environmental problems stem from an insufficient water supply. For others, too much rainfall is a detriment to crop growth. Not surprisingly, farmers are anxious.

Matthew Russell is an Iowan farmer whose family has tended to their land for five generations. In an interview with Medical Daily, he recounts the physical and psychological toll brought on by extreme climate conditions:

“Psychologically, in the last few years, there’s a lot of anxiety that I don’t remember having 10 years ago. In the last three or four years, there’s this tremendous anxiety around the weather because windows of time for quality crop growth are very narrow.”

Russell explains that this narrow window is due to increasing levels of rain, which leave his land muddy and wet, decreasing crop quality.

Aside from droughts and flooding, extreme temperatures compound the problem, as do weeds, pests, and fungi that thrive better as a result of warmer temperatures and increased carbon dioxide levels.

For those like Russell who have farmed throughout their lives, the idea of uprooting and relocating or finding a new profession seems daunting. With the continuing effects of climate change, this threat may soon become reality.

Anxiety is not the only mental-health concern influenced by climate change. A report from the US National Library of Medicine states:

“An association has been found between crop failures due to unexpected droughts and suicide attempts by the farmers. Failure of a crop can lead to economic hardships. When dependent on low precipitation situations, the farmer might not be able to sustain the expenses of the family and may become a victim of the debt trap to meet the expenses.”

Although the report focuses on droughts in Australian and Indian populations, these experiences are echoed elsewhere, like in California. Drought there has contributed to failed crops for farmers, as well as increased food prices for consumers in North America. A 2012 report showed that the economic hardship associated with these problems has increased the risk of suicide in American farmers.

A study on suicide by Ryan Sturgeon at the University of Calgary examined the content of calls to a rural stress line from farmers in Manitoba, Canada. He found that farmers may not be using the mental health resources open to them:

“Multiple factors may negatively impact farmers’ help-seeking behavior, including greater isolation due to a growing distance between farms, increased competition, and less cooperation among farmers because of the changing global economy, and fragmentation of existing rural communities as more people are moving off farms and into urban areas.”

Problems brought on by climate change are exacerbated in vulnerable rural communities populated by farmers. But as a worldwide phenomenon, climate change is likely to affect mental health globally.

–Andrei Nistor, Contributing Writer, The Trauma and Mental Health Report. 

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

This article was originally published on Psychology Today

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Pregnant Women Struggle with Managing Psychiatric Medication

60Anxiety, Featured news, Health, Pregnancy, Psychiatry, Psychopharmacology, Suicide November, 17

Source: Lauren Fritts at flickr, Creative Commons

It is often portrayed as a happy and exciting time but the experience of pregnancy can be mixed, with physical and mental complications dampening the experience.

In a recently released documentary, Moms and Meds, director Dina Fiasconaro addresses the challenges that she and other women with psychiatric disorders face during pregnancy.

Fiasconaro’s goal in making the documentary was to investigate women’s experiences with psychotropic drugs at this life stage. She became pregnant while on anti-anxiety medication and had difficulty obtaining clear information from healthcare professionals.

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

“I received very conflicting information on what medications were safe from my psychiatrist, therapist, and high-risk obstetrician. Even with non-psychiatric medication, I couldn’t get a clear answer, or from the pharmaceutical companies that manufactured them. No one wanted to say ‘that’s okay’ and be liable if something were to go awry.”

When she spoke to her maternal/fetal specialist, she was provided with a stack of research abstracts regarding the use of certain psychotropic medications during pregnancy. Although the information was helpful, it didn’t adequately inform her about the risks and benefits of medication use versus non-use.

One of the main questions Fiasconaro had was, should she continue using medication and risk harming her baby, or should she discontinue use and risk harming herself?

One of the women featured in Moms and Meds, Kelly Ford, contemplated suicide several times during pregnancy. When her feelings began to intensify, she admitted herself to a hospital. There, she was steered away from taking medication which led her to feel significant distress and an inability to cope with her declining mental health.

Elizabeth Fitelson, director of the Women’s Program at Columbia University, also featured in the documentary, believes there is a tendency for healthcare professionals to dismiss mental illness in pregnant women.

In the film, Fitelson said:

“If a pregnant woman falls and breaks her leg, for example, we don’t say, ‘Oh, we can’t give you anything for pain because there may be some potential risk for the baby.’ We say, ‘Of course we have to treat your pain. That’s excruciating. We’ll give you this. There are some risks, but the risks are low and, of course, we have to treat the pain. ‘”

This lack of validation for mental health issues was echoed by Fiasconaro when she visited her doctor:

“I was referred to a high-risk obstetrician by my therapist. Although I was given the proper advice, that high-risk doctor ended up being very insensitive to my mental illness. She told me that everybody’s anxious and brushed it off like it was a non-issue. I understand that in the larger context of what she does and who she treats, my anxiety probably seemed like a low priority in the face of other, seemingly more threatening, physical illnesses.”

The ambiguous information provided by health professionals is representative of a lack of research on the risks of using medication during pregnancy.

Mary Blehar and colleagues, at the National Institutes of Health (NIH), state in the Journal of Women and Health that data are lacking on the subject. In a review of clinical research on pregnant women, they found that data obtained over the last 30 years, about which medications are harmful and which can be used safely, are incomplete. These gaps are largely due to the majority of information being based on case reports of congenital abnormalities, which are rare and difficult to follow.

During her pregnancy, Fiasconaro was able to slowly stop taking her anxiety medication. But halting treatment is sometimes not an option for women who suffer from severe, debilitating psychiatric conditions such as bipolar disorder, major depression, or schizophrenia.

We also need to improve access to information on pharmacological and non-pharmacological treatment options, including psychotherapy for women with mental-health problems during pregnancy. Without adequate guidance, the management of psychiatric conditions can leave many feeling alone and overburdened. These women often feel stigmatized and neglected by healthcare professionals. The development of supportive and informative relationships is necessary to their wellbeing.

As Fiasconaro put it:

“I had to be pretty focused and tenacious in finding information and then making the most informed decision for myself. I’m grateful I was able to do so, but again, I know every woman might not be in that position, and it can be very scary and confusing.”

–Nonna Khakpour, 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