Category: Psychiatry

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What if Your Father Were a Pedophile?

00Embarrassment, Family Dynamics, Featured news, Psychiatry, Punishment, Relationships, Trauma August, 18

Source: Feature: enki22 at flickr, Creative Commons

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

– Stefano Costa, Contributing Writer, The Trauma and Mental Health Report

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

“Copyright Robert T. Muller”

This article was originally published on Psychology Today

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Surprising Side Effect of Parkinson’s Drug: Creativity

00Career, Creativity, Dopamine, Featured news, Psychiatry, Psychopharmacology, Self-Control August, 18

Source: Image Credits Feature: Ingrid Hauff, Used With Permission

In 2014, Ingrid Hauff was diagnosed with Parkinson’s disease (PD), a degenerative disorder that attacks the nervous system, leading to speech impairment, loss of control over body movement, and a long list of other symptoms. Plus, there is no cure.

Struggling with the diagnosis, Hauff checked herself into a psychiatric clinic where she was introduced to art therapy. The clinic supplied her with materials, and the staff asked her to paint what she felt. She initially used painting as a way to cope with the illness.

Hauff tells the Trauma and Mental Health Report:

“Before my diagnosis, I never painted. I could never have imagined that painting would be so important to me like it is today. I paint every day. It is a great pleasure for me to paint. I forget every trouble, and I find the [disease’s] side effects are lessened.”

Painting has become more than therapy for Hauff. It’s now a fundamental part of her life, and her unique artistic style and choice of colour have helped her become a successful artist. She has even held an exhibition of her landscape paintings in Berlin.

But her story of artistic knack and creative development is, surprisingly, not a rare one for those diagnosed with PD. Some scientists are investigating whether medications, such as Levodopa and Pramipexol, prescribed to relieve PD symptoms, heighten creativity. These drugs increase the neurotransmitter dopamine, a chemical in the brain that regulates movement. Dopamine is gradually depleted as PD progresses, so boosting this neurotransmitter allows patients to retain regular movement and regain control over their bodies.

Like all medications, though, these drugs have a multitude of side effects, ranging from headaches and nausea, to tremors and hallucinations. Unlike other medications, however, one side effect stands out from the rest: uninhibited creativity.

Neurologist Rivka Inzelberg and colleagues published a study in 2014, finding that patients treated with dopaminergic drugs showed enhanced verbal and visual creativity in comparison to neurologically healthy individuals who were not on the medication. This is one of several studies where Inzelberg demonstrated that PD medications are associated with higher rates of creative capability.

But in some instances, patients claim to produce artwork to a point where they can’t restrain themselves. Eugénie Lhommée and her colleagues interviewed people with PD and published a case study on the influence of increased dopamine on creativity. In it, the patient reported:

“I transformed my home into a studio, with tables and canvases everywhere [and] started painting from morning till night. I used knives, forks, sponges […] I would gouge open tubes of paint—it was everywhere. I started painting on the walls, the furniture, even the washing machine. I would paint any surface I came across. I could not stop myself from painting and repainting every night in a trance-like state. My partner could no longer bear it. People close to me realized that I crossed some kind of line into the pathological, and, at their instigation, I was hospitalized.”

Hauff also experienced an “extreme influence” on her artwork when prescribed Pramipexol:

“I began painting for hours every night. I didn’t have any ability to stop. I lost a lot of sleep and was constantly without energy after these sessions, so I decided, together with my neurologist, to stop [Pramipexol]. I’ve been off of it since the beginning of February 2017, and now after one month [on new medication], I can declare that my feeling of control has come back.”

While these experiences can be damaging to patients and their loved ones, Hauff was able to take advantage of this unique side effect by exhibiting and selling the artwork she had produced. Her solution to the problem was to switch to a different medication. The creative boost remained, but the compelling drive disappeared. Hauff explains:

“My creativity is still there, but the ‘painting time’ is now reduced radically. I am painting only during the daytime. My opinion is that Pramipexol limits my ability to maintain self-control.”

But Hauff has no regrets about her experience with Pramipexol:

“It let me find my creativity and showed me what I can do. It showed me secret parts of my soul. It showed me what has slept in my brain and in my heart for nearly 60 years. It showed me a way to live with my Parkinson’s.”

As is the case for most individuals considering a drug therapy, people with PD have to weigh the benefits and drawbacks of medication options. But as more research on this unexpected and artistic by-product emerges, it begs the question of whether similar medications can be used to boost creativity in the future.

– Ty LeBlanc, 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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For Mentally Ill, Jail Diversion Program Gives Second Chance

30Featured news, Health, Law and Crime, Loneliness, Politics, Psychiatry, Psychopathy March, 18

Source: octopusdevon at flickr, Creative Commons

On February 8, 2015, Natasha McKenna—a 37-year-old who suffered from mental illness—died following an incident in which she was tasered four times by law enforcement.

After a week-long delay in transporting her to a county jail in Virginia, where she would be provided with mental-health resources, she became agitated. In an effort to regain control, officers used a stun gun on her multiple times. Despite CPR to revive her, McKenna passed away shortly after.

McKenna had been diagnosed with schizophrenia, bi-polar disorder, and depression when she was just fourteen. Her case highlights a growing issue in county jails and prisons across America: resources are scarce for offenders with mental illness.

In 1992, the National Alliance for the Mentally Ill (NAMI) and Public Citizen’s Health Research Group released a report revealing alarmingly high numbers of people with serious mental illness incarcerated in the United States. The subsequent 2002 report showed that little had changed in the preceding ten years.

But shortly after McKenna’s death in 2015, Fairfax County Jail—where she had been held—created a Jail Diversion Program (JDP). The objective of this program is to divert low-risk offenders in mental-health crises to treatment rather than send them to a prison setting that exacerbates their symptoms.

JDPs are designed so that authorities, alongside certified crisis clinicians, have the capacity to decide whether a non-violent offender who suffers from a mental disorder is directed to a JDP where they can receive treatment, or is arrested. JDPs give offenders the opportunity to work with a trained mental-health clinician, ultimately transforming how resources are provided.

Sarah Abbot, the program director of Advocates—a JDP in Massachusetts that works with the Framingham Police Department—believes that JDPs are crucial in early intervention for mentally ill offenders.

During an interview with the Trauma and Mental Health Report, Abbot explained:

“JDP’s effectively divert people with mental illness from the criminal justice system, and have been shown to be successful in the prevention of unnecessary arrests for those who suffer with a mental illness. Police choose to transfer offenders to JDPs 75% of the time.”

Abbot believes that early intervention via JDPs is key to preventing those with a mental illness from reoffending. In 12 years of operation, Advocates has successfully diverted 15,000 individuals from the criminal justice system into treatment.

During calls related to misdemeanors, police respond to the scene with a JDP clinician. After consulting the clinician, the officers use their discretion, along with information from victims and bystanders, to decide whether or not to press charges. Alternatively, the officer can choose to secure treatment for the offending individual at a JDP.

In the latter case, the clinician performs an assessment to determine if the offender meets the criteria for inpatient care. If so, they are diverted from arrest and placed in a local mental-health facility where they receive intensive treatment through the support of counsellors, social workers, psychologists, and psychiatrists.

The purpose of JDPs is to de-escalate encounters with mentally ill offenders and create a cooperative environment for assessing the situation. Abbot views their contribution as a form of compassionate justice:

“If we can keep mentally ill individuals out of the criminal justice system, their lives will ultimately be better by default. How much better depends on the quality of the treatment they receive and the individual’s commitment to success.”

The literature on JDPs suggests that placing these individuals in treatment programs within their community, where they have the support of family and friends, inevitably results in lower rates of relapse in comparison to incarceration.

Abbot believes that JDPs are vital in keeping individuals away from the isolation of a jail cell:

“My hope is that we divert people like Natasha McKenna into proper treatment, because once they are in a cell, things can escalate quite quickly.”

If somebody with a mental illness has an arrest on their record, JDPs keep doors open to them for education, employment, and housing. JDPs have the potential to protect individuals like McKenna, and provide offenders suffering from mental illness with a second chance at living stable lives post-arrest.

–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

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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

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Pregnant Women Struggle with Managing Psychiatric Medication

00Anxiety, 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

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Police Need Training to Deal With Mentally Ill Offenders

00Featured news, Health, Law and Crime, Post-Traumatic Stress Disorder, Psychiatry, Psychopathy, Stress October, 17

Source: Free Images at Pixabay

On March 4, 2016, Devon LaFleur, a 30-year-old struggling with bipolar disorder, went missing. His father contacted law enforcement to notify police of his son’s mental illness and tendency towards violence. After learning that LaFleur had allegedly robbed a bank and was on the run, Toronto police tracked down and fatally shot the young man during a confrontation.

In many instances where mental illness is concerned, police officers respond too quickly with force. In an analysis conducted by The Washington Post, American officers shot 124 people who showed some sign of mental or emotional distress in 2015.

The Post explains that, for the majority of these crimes, the police were not called for reports of criminal activity. As in LaFleur’s case, police were contacted by “relatives, neighbors or other bystanders worried that a mentally fragile person was behaving erratically.”

An article by psychiatry professor Richard Lamb and colleagues at the University of Southern California reports that police officers are authorized to transport individuals with mental illness for psychiatric evaluation when there is reason to believe that they pose a danger or threat. But the researchers also state that this responsibility turns officers into ‘street-corner psychiatrists’ without giving them the training they need to make on-the-spot decisions about mentally ill offenders.

An article published in Criminal Justice Review by Teresa LaGrange shows that “higher educated police officers recognize a broader range of disorders” and they are more likely to “view the situation as requiring a professional intervention.”

However, LaGrange also recognizes that instead of teaching practical skills like learning how to identify individuals with mental-health conditions, many educational workshops only consist of general descriptions about psychological terms and concepts.

Police officers need to know how to handle individuals who display different types of mental illnesses. The Washington Post analysis states that the most extreme cases of mentally ill people causing a disturbance were schizophrenic individuals and those who displayed suicidal tendencies or had some form of post-traumatic stress disorder (PTSD).

In some states, crisis intervention team training (CIT) is being implemented to help officers identify mental illness and determine the best course of action.

CIT consists of a 40-hour training program for police forces that educates officers on mental-health issues and medications and teaches about mental-health services in the local community. CIT also teaches methods that help de-escalate heated situations by encouraging officers to allow vulnerable individuals to vent their frustrations—methods that could have been useful in LaFleur’s case to reduce the risk of violence from both the police and offender.

So far, this program has been considered effective by the police departments using it.

Major Sam Cochran of the Memphis police department, a retired officer and a coordinator of the CIT program, emphasizes that law enforcement should partner with local mental-health agencies: “If communities give attention only to law enforcement, you will fail as a training program. You cannot separate the two.”

Although the task of identifying mentally ill individuals can be daunting, these training programs are a step toward preventing injustices for individuals like LaFleur. Providing officers with appropriate training not only improves the ability to handle job stress but may also provide mentally ill offenders with a chance to receive treatment.

–Afifa Mahboob, 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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At CAMH, Pet Therapy Helps Decrease Stigma

00Emotion Regulation, Featured news, Happiness, Law and Crime, Loneliness, Psychiatry, Therapy May, 16

Source: Ryan Faist, Used With Permission

When I tell others that I volunteer with my dog in a pet therapy program, they assume my work involves children or the elderly. I am not surprised: the benefits of animal-assisted therapy for these groups are widely known.

But my dog Rambo’s “patients” are quite different. He and I volunteer at an inpatient unit at the Centre for Addiction and Mental Health (CAMH) in Toronto. The people Rambo sees every Tuesday reside in the Secure Forensic Unit.

Accused of committing crimes ranging from shoplifting to homicide, these individuals all suffer from severe mental illness. Their treatment at CAMH is court-ordered, and they are routinely assessed by mental health professionals to determine if they can be held responsible for their crimes.

Theresa Conforti, the co-ordinator for Clinical Programs and Volunteer Resources at CAMH, explains how pets factor into the equation:

“For the past 10 years, CAMH has had their own Pet Therapy Program that is very unique and caters only to the clients at CAMH. The clients value the unconditional love and affection the dog gives them on a weekly basis. The importance is that this program bridges the gap for those who have had to leave their furry friends to come to treatment, and for those who will not be able to own a dog due to financial restrictions or housing situations. The weekly visits ease loneliness, improve communication, foster trust, decrease stress and anxiety, and are a lot of fun!”

The program assesses the volunteers for eligibility, while the dog goes through an evaluation with a professional service dog trainer. Conforti notes:

“This works because those interested in volunteering at CAMH are not here to stigmatize our patients, rather they are here to make a difference and di-stigmatize mental illness.”

To say the experience has been rewarding for volunteers like me would be an understatement. Patients are happy to see Rambo, talk to him, pet him, or just be in the same room with him. Not only does he give them a break from their daily routines and the confinement of their unit at CAMH, but he also offers unconditional affection to those in the program.

And while the benefits of pet therapy are numerous, unconditional affection is the critical point here.

When people find out where Rambo and I volunteer, I am often asked whether I fear for our safety, highlighting the common misconception that individuals with severe mental illness are dangerous and violent. Stereotypes like this further perpetuate mental illness stigmatization.

But animals do not judge. They do not care about physical appearance, diagnoses, or criminal history. Conforti recalls:

“One of our dogs went on a unit and a selective mute client—a client who chooses not to speak—had knelt down and whispered in the dog’s ear. No one heard what the client said to the dog, but it was the first time the client had ever spoken. And he had chosen to do so to a dog that will not judge nor will expect much from him. I love that story because it shows that dogs are there to help, love unconditionally, and, most importantly, they do not stigmatize.”

This may be one reason animal-assisted therapy programs are gaining popularity globally. A program in Bollate, Italy, has introduced the use of dog therapy for prison inmates. Valeria Gallinotti, the founder of the program, explains:

“My dream was to organize pet therapy sessions in prison because it’s the one place where there is a total lack of affection, where dogs can create calm, good moods, emotional bonds and physical contact.”

The program has been a hit with inmates, who look forward to the dogs’ visits and have formed a sense of close companionship with them. When asked who his favourite dog was, one of the inmates said:

“Carmela arrived and didn’t know what to do. She was so scared, sort of like us when we arrive in prison. Now, like us, she too is getting used to the experience.” 

Whether part of psychotherapy, physiotherapy, or a prison inmate program, animal assisted therapy can give people the extra motivation needed to get through the challenge of treatment or confinement. Patients and clinicians alike have a lot to gain from therapists like Rambo.

– Essi Numminen, 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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Killing the American Hero, Killing the Fair Trial

00Attention, Featured news, Health, Law and Crime, Media, Post-Traumatic Stress Disorder, Psychiatry, Psychopathy April, 16

Source: Quadraro on DeviantArt

Was he “insane” or not? That is the question jury members in Erath County, Texas addressed, on February 25th, 2015, during three hours of deliberation in the Eddie Ray Routh case.

Routh, a veteran of the Iraq war, was convicted of murder after he shot two fellow veterans, Chad Littlefield and Chris Kyle, who was famously known as the most prolific sniper in American history and whose memoir inspired the blockbuster film, American Sniper. Kyle, who worked to help veterans cope with post-traumatic stress disorder (PTSD), was asked by Routh’s mother to see if there was anything he could do for her son. When Routh, Littlefield, and Kyle went to a shooting range—a routine practice used by Kyle to help veterans ‘blow off steam’—Routh opened fire, killing both men.

Routh’s defence lawyers pursued an insanity plea, citing a diagnosis of paranoid schizophrenia as the reason for his actions.

According to section 8.01a of the Penal Code of Texas, an individual may successfully plea not guilty by reason of insanity if evidence proves that at the time of the incident, the accused, as a result of “severe mental disease, did not know that his conduct was wrong.” Citing a police interrogation that took place after the incident—not before, as outlined by law—where Routh answered that he knew what he did was wrong, prosecutors argued that the defense was invalid. The jury agreed, and Eddie Ray Routh was sentenced to life in prison with no chance of parole.

Decisions in so-called insanity cases are often controversial. Routh’s case calls into question the legal system’s impartiality and treatment of mental health issues, in particular.

The case was widely publicized for its duration, which coincided with the release of American Sniper. The film was highly acclaimed and portrayed Chris Kyle as a hero, especially for the townspeople in Erath County. Typically, when a jury from a particular area is likely to be biased, it is common practice for defense lawyers to move the trial outside the district in which the crime was committed. In Routh’s case, this motion was denied, despite some jurors even admitting to having seen American Sniper before making their decision.

In addition to lacking impartiality, the Texas court also failed to properly account for Routh’s mental health.

Routh was diagnosed with paranoid schizophrenia by a psychiatrist prior to the incident at the shooting range. His medication was found when police raided his home. According to Routh’s family and friends, he had also experienced episodes of aggression, irritability, suicidal thoughts and attempts, and psychotic episodes. These episodes consisted of extremely erratic delusions ranging from vampires and werewolves, to him believing he was God and Satan.

But the insanity exclusion in Texas does not take a holistic view of an individual, instead using narrow and limiting language to define insanity. While Routh may have agreed that his actions were wrong after the event, there is no way to know what he was experiencing throughout. And if his previous psychotic episodes are representative, he may have been psychologically removed from reality at the time of his actions, possibly believing he was acting to save his own life.

Some argue that Routh and others like him should still be held responsible for their actions, despite their mental health problems. But, what many do not understand, is that being found not guilty by reason of insanity does not mean the individual walks free. In many cases, such a verdict could lead to extremely long detention in a psychiatric institution, where individuals are kept under close watch as they undergo treatment for their disorder.

In refusing to accept Eddie Ray Routh’s insanity plea, the Texas legal system is doing more than just punishing an individual who may not have been aware of his own actions, they are also denying treatment to a seriously ill person. At this rate, many mentally ill individuals will continue to be punished for actions they did not intend or understand, never receiving treatment and never having a chance to recover.

For more details about the Not Criminally Responsible Defense (as it is known in Canada), see our article entitled Myth Busting the Not Criminally Responsible Defence.

– Alessandro Perri, 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

1 A blood test to diagnose depression-118138414119886042cd33f08a35cf742e1cc5c5

A Blood Test to Diagnose Depression?

00Addiction, Depression, Featured news, Neuroscience, Psychiatry, SSRIs March, 16

Source: Andrew Mason on Flickr

Researchers at the Feinberg School of Medicine at Northwestern believe it may be possible to diagnose depression using a blood test. According to Eva Redei, a professor of psychiatry at the university, previous studies with lab animals have identified 26 markers in the blood (called biomarkers) that are associated with depression.

With human subjects, Redei identified nine biomarkers that differed between depressed and non-depressed individuals. The biomarkers signify a difference in gene expression associated with depression and allowed Redei to identify all those suffering from Major Depressive Disorder (MDD) in a sample of 66 adults.

Further, Redei was able to use biomarkers to identify adults with MDD who benefited from Cognitive Behavioural Therapy (CBT).  When depression symptoms were improving, some of the original biomarkers that helped to identify depressed individuals disappeared in blood samples.

If replicable, these findings would have major implications for the future of mental health diagnosis. Patients sometimes seek the attention of a primary care physician when they have concerns about depression. Unfortunately, such physicians are not as equipped or experienced as psychiatrists and psychologists in diagnosing and treating depression. This increases the time between when individuals begin to experience symptoms and when they are able to receive treatment. On average, an official depression diagnosis can take between 2 to 40 months.

At the same time, untreated depression has severe risks. “The longer depression is not treated, the more difficult it is to treat,” says Redei. “There’s also a higher chance of suicide, and adverse effects in the person’s work environment, home environment, [and] social structure.”

Untreated depression usually worsens over time, and to cope, patients may succumb to addiction, self-injury, and reckless behaviors such as having unprotected sex and drunk driving. Risk of suicide also goes up the longer depression remains untreated.

Using a test such as this to identify depression could reduce some of the stigma tied to the disorder and bridge the gap between mental and physical health. Depression affects the whole person, body and mind. A test such as this underscores that connection.

Does it all sound too easy?

Perhaps.  New biological findings in mental illness have a way of promising a whole lot more than they deliver.

Nowhere is this seen more than in the area of depression (Anyone out there remember Peter Kramer’s 1993 classic, Listening to Prozac?)  Decades of research on SSRI’s, once hailed as revolutionary, are increasingly showing just how modest, indeed disappointing, the medication’s effects actually are.

So a healthy dose of skepticism is in order.

This study is one of the first in its category. Depression is an exceptionally complex disorder that can only be partially understood in terms of biology. For the above implications to be substantiated, many studies with larger sample sizes must replicate the findings.

In fact, a much larger study that looked for genetic associations with MDD in over 6,000 individuals (of whom 2,000 were diagnosed with MDD) found little to no genetic links.

Further, even if blood sampling were used to diagnose depression, it would not account for the social and environmental components of the disorder. It is possible that increased reliance on biological factors could lead to increased numbers of people being misdiagnosed and forced to suffer alone due to the narrow diagnostic scope that blood tests would provide.

Still, Redei’s research does show promise. She hopes that using blood tests to diagnose depression will help expedite the otherwise lengthy process. But she does not feel that current diagnostic practices should be replaced. Instead, the combination of blood tests and self-report evaluations of symptoms may be key to early diagnosis in the future.

Although further research is needed, the hope is that blood tests may eventually help clinicians with the question of which treatment may be most effective for which client. “I think this opens the possibility to begin to look at whether there are biomarkers that may be able to predict response to a behavioral treatment like cognitive behavioral therapy, pharmacotherapy and other forms of treatment,” says co-author David Mohr.

Redei’s research responds to the very real need for more efficient and effective methods of diagnosing depression.  And it opens doors to new ways of understanding the disorder and its identifying characteristics.

– Alessandro Perri, 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

Is Online Treatment the Next Frontier for CBT?

Is Online Treatment the Next Frontier for CBT?

10Cognitive Behavioral Therapy, Depression, Featured news, Psychiatry, Therapy, Trauma December, 15

Source: Mark Anderson on Flickr

Social media have dramatically changed the way many of us connect with family and friends. Some are now proposing that online relationships, particularly online therapeutic relationships may revolutionize mental health services by giving people with limited access a viable alternative to traditional treatment approaches.

One of these online alternatives, iCBT (internet-based Cognitive Behavioural Therapy) was derived from the tenets of traditional CBT pioneered by psychiatrist Aaron Beck.

Both target automatic negative thoughts that people have about themselves, the world, and their future, thoughts considered to be central to disorders like depression and anxiety.

But unlike traditional CBT where clients and therapists regularly meet in person, iCBT requires individuals to keep a journal recording their state of mind on an ongoing basis. Clients are given cognitive exercises, and their progress is tracked remotely by a therapist who reads the self-reflective journals, with feedback provided by e-mail.

The approach is currently being tested for its effectiveness in treating Generalized Anxiety Disorder (GAD). Psychologist and online therapist Marlos Postel conceptualizes iCBT as an approach that combines the advantages of structured self-help materials with the expertise of a therapist who directs activities and encourages clients.

Research from the University of New South Wales in Australia reports promising results, including improvements in patients with GAD, even compared to face-to-face treatments, with therapeutic gains maintained over three years.

Notably, many argue that online treatments eliminate an important ingredient, the therapeutic relationship between clinician and client. Research on the importance of this clinical relationship, the working alliance, has consistently shown it to be the single largest factor in predicting outcome. A central element of psychotherapy, it fosters trust, collaborativeness, and therapeutic change.

And some argue that underlying a strong alliance is the ability to detect non-verbal cues and subtle shifts in emotion that a client may demonstrate during therapy. Psychologist Madalina Sucala and colleagues from Mount Sinai School of Medicine in New York found that these cues account for a greater proportion of psychotherapy outcome than does treatment modality.

Notably, a different study conducted by Sucala found e-therapy and face-to-face approaches equivalent in outcome, despite the absence of non-verbal cues in e-therapy.

These discrepancies led researchers Gerhard Anderssona and Erik Hedman to suspect that some aspects of e-therapy may foster a different type of alliance between therapist and client. In a recent study, they found that iCBT creates a strong emotional connection between client and therapist because the therapist has more time to critically reflect on clients’ cases. Similarly, the online interactions did not affect client perceptions of how much their therapist cared for them or how much they trusted the therapist.

And co-director of the eCentreClinic and psychologist Nickolai Titov, an advocate for e-therapy, lists a number of advantages of the approach in a recent report. He found that iCBT is less-expensive—often 20-40% the cost of traditional therapy—and presents a viable alternative for rural locations where therapists are less accessible. Titov also found that many people can benefit from the relative anonymity of iCBT, as a common barrier to seeking therapy is embarrassment and fear of disclosure.

Therapists using modalities other than CBT have also started to come online. Clinicians using behavioural, interpersonal, and emotion-focused approaches have also begun offering online treatments. Even psychodynamic psychotherapy, which is traditionally a long-term, relational form of counselling, has been adapted into online formats.

Still, face-to-face mental health treatments are far from being replaced. Just as older styles of therapy are used alongside newer ones, online therapy may represent a promising treatment option for those comfortable with the format.

– Sumeet Farwaha, 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