Category: Psychopathy

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The Making of a Murderer

00Child Development, Featured news, Genetics, Law and Crime, Parenting, Psychopathy July, 18

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In 1993, when Robert Thompson and Jon Venables from Liverpool, England were both 10 years of age, they killed a two-year-old boy. Thompson and Venables kidnapped the victim from a shopping centre, tortured him, and left him to die.

Stories like these raise many questions. Chief among them, how does something like this happen at all? Was it the result of bad parenting? The community certainly thought so, viewing the boys’ upbringing as the cause.

The trial had exposed evidence of domestic problems in both families. The judge stated that Thompson’s and Venable’s parents must take moral responsibility for their children’s actions. So members of the Thompson family had to assume new identities and go into hiding. They moved nine times to escape verbal and physical attacks. The Venables experienced similar threats.

In a recent interview with CNN, family therapist Tricia Ferrara put the onus on parents to understand when their child is in trouble. She said:

“All parents need a better understanding of child development so we can detect when the signals show a child may be moving in an anti-social direction.”

And a study conducted on the Columbine shootings, where two teenagers killed 12 students and a teacher at Columbine High School in Denver, suggested that the community saw parents as partly accountable for the murders.

There’s no doubt that parenting plays an enormous role in child development. Researchhas found that abuse, negative parenting, and prolonged malnutrition are linked to a proclivity toward physical violence.

But, there is also important research pointing to the role biology plays in predisposing some individuals to psychopathy, including violence. The BBC reported that neuroscientist Adrian Raine discovered a decrease in activity of the pre-frontal cortex in the brains of murderers, suggesting a genetic predisposition.

And, research by Elizabeth Cauffman and colleagues from the University of California found that good parenting doesn’t always lead to the outcomes we imagine. In fact, anti-social encouragement by a romantic partner was correlated with the highest level of offending in youth, even when warm relationships endured with parents.

In a TVO documentary Genetic Me, professor Daniel Nettle claimed that personality is stable throughout a person’s life. Individuals have tendencies for some things and not others. Nettle suggests that people are born with predispositions for certain personality traits. He adds, though, that the environment has some effect on bringing out theses inclinations, and that people can fight against them.

NPR reported that there are additional factors that play into a person’s development, perhaps explaining why not all children raised by the same parents are violent. Children in the same families have distinct personalities and varied interests that elicit different parenting. Plus, children experience independent social environments outside the home.

Perhaps the complexity of the matter is described best by neurobiologist James Fallon, who studies the brains of psychopathic killers. He explained in a TED Talk that an interaction occurs between environment and genetics. When presented with a particular brain image, he noted it was clearly a psychopath’s brain. What was most shocking—it was his own brain. Fallon, though, is not a killer, and had a happy upbringing. But, he has a family history of homicide. The first documented murder of a mother by a son was committed by a member of his family, several generations back.

Fallon said that, although some individuals, mostly male, have genes or brain damage that make them more susceptible to becoming murderers, their childhood experiences can make all the difference. For instance, the MAOA gene in particular can give rise to a violent individual if the gene is combined with experiences of brutality.

Where do murderers come from? Like all the big questions in mental health, an either-or perspective leaves little room for complexity. In the great genetics versus environment debate, the making of murderers—indeed, the making of us—requires that we look somewhere in-between.

–Anika Rak, 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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Domestic Abuse Linked to Financial Crisis

00Domestic Violence, Featured news, Health, Marriage, Psychopathy, Relationships, Stress June, 18

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Self-reported spousal violence has declined in most Canadian provinces over the past ten years, according to Statistics Canada. But an increase in domestic violence calls to the police in the province of Alberta was reported for 2016 by The Globe and Mail. The increase occurred concurrently with the loss of thousands of jobs in the mining and oil industries.

This connection has also been established in other countries. During the financial collapse in Greece, the Greek police reported a 53.9% increase in family violence in 2011 from before the crisis in 2008. Additionally, when sociologist Claire Renzetti and colleague reviewed research in the United States, they found evidence of a relationship between economic stresses and domestic abuse.

Another study of American households indicates that intimate partner violence occurs at disproportionate rates among impoverished groups of women. The World Health Organization states that 13-61% of women worldwide recount experiencing physical violence from a partner at some point in their lifetime, and that poverty is a risk factor.

In an interview with the Trauma and Mental Health Report, Barbara MacQuarrie, the community director of the Centre for Research and Education on Violence Against Women and Children at Western University, described the link:

“At the heart of domestic violence is a dynamic of power and control, where one person feels they have the right to control another. When one loses control over their finances, they may attempt to regain that control by controlling their spouse through physical violence and other abusive tactics.”

Awareness of how financial stressors affect violent behaviour becomes important during times of financial hardship, such as economic recessions. Although macro research on the influence of economic crises on domestic violence is limited, the findings in Alberta, Greece, and the United States are telling. There are also personal accounts of spousal aggression surrounding financial problems.

Anne (name changed for anonymity), a survivor of domestic violence, recounted her experience to the Trauma and Mental Health Report. She recalled financial struggles preceding violent episodes from her previously non-violent husband.

In 1991, Anne moved from Russia to Canada to join her husband Jonathan (name changed). This move coincided with a severe recession beginning in the early ’90s. Johnathan’s wages were cut in half, to the detriment of the family. A once promising future was now out of reach. In Anne’s words:

“I needed to work to help ends meet. Because I took care of our children and household during the day, I had to work at night. I cleaned at a corporate office for minimum wage, so money was tight. “

Months after the move to Canada, arguments became heated, and he became more aggressive, at one point, pushing her hard enough that she hit her head against concrete, and fell unconscious. Anne believes that their financial stresses brought out another side of Jonathan that led him to become both physically and emotionally abusive. She decided to leave, but was afraid for her life and the safety of her children if she did.

“He was supposed to be my partner, but instead of my being able to go to him for help or support, I feared him. “

Women who are survivors of domestic violence are right to feel afraid. The Canadian Women’s Foundation reports that 26% of women killed by their spouse are killed after they leave the relationship, and women are six times more likely to be murdered by an ex-partner than a current partner. Nonetheless, with proper planning and support, women can safely leave a violent situation. Anne said:

“When Jonathan left on a work-related trip, I took the children with me to a women’s shelter. It was highly secure, padlocks on every door, and a security guard at the main entrance. Eventually we moved into an apartment.”

Anne and her children now live safely. She encourages those who are facing potential domestic violence to seek help immediately, especially as warning signs increase. Barbara MacQuarrie explains that more than one risk factor in the perpetrator increases the chances of violence:

“Unemployment is a very significant risk factor, especially if it’s present with other factors, such as the perpetrator having experienced abuse as a child or witnessed domestic violence.”

–Anika Rak, 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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Fascination With Murder—Should You Be Concerned About It?

00Anxiety, Ethics and Morality, Featured news, Law and Crime, Psychoanalysis, Psychopathy May, 18

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Fascinated with murder, friends and comedians Georgia Hardstark and Karen Kilgariff wanted the opportunity to openly talk about death. They started weekly podcast “My Favorite Murder” to discuss the grizzly details of crimes that interested them. Although these conversations might seem callous and unseemly to victims’ loved ones and some members of the public, the podcasts serve as a safe space for the women to confront the dark side of human nature.

In the first episode, Hardstark and Kilgariff confess their fear of being murdered, and how discussing that fear and the atrocities of true crimes eases any associated anxiety. They disclose that the process of “talking about the thing you’re afraid of” is immensely helpful. That process, they reveal, is one of the primary motivators behind the show.

Presented as a comedy, the podcast is broadcast from Feral Audio, and can also be found under the comedy category in the iTunes podcast charts. This combination of murder and humor has proven quite popular, as the podcast is regularly featured in the iTunes top comedy chart. And the show’s private Facebook group boasts over 130,000 members, or “murderinos,” as they call themselves.

So, what’s the appeal of a true crime comedy podcast? In an interview with the Huffington Post, one listener says:

“They’re honest about their fears surrounding rape, murder, kidnapping, etc. They’re terrified of those things just like the rest of us! Somehow diving into the subject helps diffuse the pain of it. It might be a weird way to desensitize ourselves from a nasty world, but, it helps!”

If that’s the case, do all consumers of true crime media have crippling fears of murder and kidnapping? Skeptics see this explanation of using the podcast as ‘exposure therapy’—wherein through systematic exposure to one’s fears, anxiety is reduced—as a justification to discuss a taboo subject matter.

Perhaps, this is not an issue of anxiety, but of the dark, unspoken desires people dare not speak.

Hardstark and Kilgariff argue that, though taboo, an interest in murder and true crime is widespread. In an interview with SBS Australia’s The Feed, the two report:

“It’s very common, but for some reason saying I have an interest in this is supposed to be a shameful thing, but it’s not. It’s very normal.”

Many listeners of the podcast report having found their “home” of sorts, a tribe where it’s okay to talk about the horrific murders that have always captivated them. Listeners appreciate Hardstark’s and Kilgariff’s candor. Another listener asserts:

“It’s a dark subject matter, but it’s treated very respectfully, and somehow Georgia and Karen manage to feed that morbid curiosity that we all share, but in a way that never forgets the consequences of violence.”

Forensic psychologist Paul G. Mattiuzzi contends that a fascination with murder is nothing out of the ordinary, and in fact, is practically built-in to people. Said plainly:

“The crime of murder is a most fundamental taboo and, also, perhaps, a most fundamental human impulse.”

Mattiuzzi maintains that the allure comes from the many questions we ask ourselves—Why did they do it? Could I do that? Was there nothing that could have stopped this?He says:

“When it’s art, all of those questions make it what we call a ‘thriller’ or a ‘mystery’. When the body is real, the ‘thrill’ may be gone, but the questions and the fascination remain.”

Psychology professor at Santa Clara and Stanford Universities, Thomas Plante, suggests:

“To deny our dark side might ultimately harm us more than accepting it and coping proactively with our inner most dark thoughts and impulses.”

Further still, the coupling of delicate subject matter with comedy or light-heartedness seems to have positive effects. Plante explains:

“Taking a light touch with dark thoughts may actually help us not act on them. Just because you have an itch doesn’t mean you need to scratch it!”

This is not to say that anyone with a passing interest in true crime secretly longs to kill, but exploring that curiosity with a “light touch” could help ease any discomfort that comes along with that interest.

Given the enduring popularity of true crime in entertainment—as seen from documentaries such as “Making a Murderer” and “The Jinx”—society’s collective fascination with murder is not going away any time soon. So, in the meantime, why not laugh about it?

—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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Solitary Confinement Is Torture

00Ethics and Morality, Featured news, Health, Politics, Psychopathy, Punishment, Suicide May, 18

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Sixteen-year-old Kalief Browder spent three years in New York’s notorious Rikers Island prison, awaiting trial for robbery. Two of those years were spent in solitary confinement. Browder’s case was eventually dismissed and, after surviving four suicide attempts during incarceration, he was released. Suffering from depression and paranoia from his years in isolation, Browder died by suicide in June of 2015.

Former U.S. President Barack Obama referenced Browder’s story in an opinion piece he wrote for the Washington Post, explaining his decision to ban solitary confinement for juveniles in all federal prisons, and calling for greater restrictions on its use as a punitive measure. New York had already ended the use of isolation for prisoners 16 and 17 years old, but in October 2016, the age restriction was extended to age 21 and younger.

In 2015, Canada’s Prime Minister Justin Trudeau moved to ban the use of long-term solitary confinement by placing a 15 consecutive-day limit on its use—as of writing, this ban had not come into effect. His decision was motivated in part by the death of Ashley Smith, a young offender who had spent more than 1,000 days in isolation. At the age of 19, while being held in solitary, Smith died by hanging herself. A coroner’s inquest ruled her death a homicide, indicating that other people’s actions were factors in her death.

Reforms are moving in the right direction, but results of a 2011 United Nations (UN) report raise the question—should isolation be permitted under any circumstances? UN Special Rapporteur Juan E. Mendez said in this report:

“Solitary confinement, [as a punishment] cannot be justified for any reason, precisely because it imposes severe mental pain and suffering beyond any reasonable retribution for criminal behaviour and thus constitutes an act defined [as] … torture.”

Nevertheless, according to the National Conference of State Legislatures, many American states impose no restrictions on the use of solitary confinement, even for juveniles. In Canada, there is currently no limit on how much time a prisoner can spend in solitary confinement. And, if adopted, the limits proposed by Trudeau will only affect federal prisons.

According to an American National Survey by the Association of State Correctional Administrators at Yale, “between 80,000 and 100,000 people were in isolation in prisons as of the fall of 2014.” In Canada, The Globe and Mail reports, “1,800 Canadian inmates are held in segregation on any given day.”

According to Mendez, the adverse health effects of this type of imprisonment are numerous, and include ‘prison psychosis,’ which can lead to anxiety, depression, irritability, cognitive disorders, hallucinations, paranoia, and self-inflicted injuries. Mendez concluded that “solitary confinement for more than 15 days…constitutes cruel and inhuman, or degrading treatment, or even torture”—well below the time Browder and Smith spent in isolation.

The adverse effects of solitary confinement on mental health have a long history of documentation. David H. Cloud, head of the Vera Institute of Justice’s Reform for Healthy Communities Initiative, stated:

“Nearly every scientific inquiry into the effects of solitary confinement over the past 150 years has concluded that subjecting an individual to more than 10 days of involuntary segregation results in a distinct set of emotional, cognitive, social, and physical pathologies.”

These findings prompted Kenneth Appelbaum from the Center for Health Policy and Research at the University of Massachusetts Medical School to write an article calling for American psychiatry to join the fight against the use of solitary confinement.

Many prison administrators disagree. In an interview with the Boston Globe, the Massachusetts Commissioner of Correction defended the use of solitary, explaining:

“We have to be realistic when we’re running these prisons. Segregation is a necessary tool in a prison environment.”

An article by Corrections One, an online news outlet for the correctional field, explains that segregation keeps jails safer by removing violent and dangerous inmates from the prison population, in the same way that imprisonment removes dangerous people from society. Segregation, the article states, is primarily used on prisoners that pose a risk of harm to themselves or others.

Speaking with the Canadian Broadcasting Company (CBC), Lisa Kerr, law professor at Queen’s University in Southern Ontario, reported that:

“Prison administrators have long been convinced that they cannot manage their institutions without easy, limitless recourse to segregation.”

Watch-dog groups point out that other countries apply the use of solitary confinement more selectively and with greater oversight than is used in North American prisons. In the U.K., while solitary is still in practice, the number of prisoners subjected to this form of punishment is much lower. Even more progressive are correctional institutions in Norway, where prison reform has moved away from punitive approaches and has placed rehabilitation and reintegration as a key focus during incarceration.

Eliminating the use of solitary confinement for juveniles is a promising first step towards abolishing the practice entirely. While supporters of solitary may not feel there are effective alternative punishments, human rights advocates continue to fight for prison reform. Looking at solutions used in other countries, perhaps more effective and humane incarceration methods can be realized, and the current paradigm of punishment may shift.

–Stefano Costa, 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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For Those With Schizophrenia, Writing Can Help

30Creativity, Featured news, Health, Integrative Medicine, Psychopathy, Self-Help, Therapy March, 18

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A myth in popular culture: Mental illness leads to creativity. The idea is bolstered by successful movies like Total Recall, Minority Report, and Blade Runner, based on the work of author Philip K. Dick, who struggled with schizophrenia. Other notable artists, like singer-songwriter Brian Wilson from The Beach Boys, also showed schizophrenic symptoms.

These links have led scientists to question the relationship between schizophrenia and creative expression. While a connection appears to exist, the assumption that schizophrenia can cause creativity (or vice versa) doesn’t hold up, not in any simple or direct way. Often, these assumptions overlook other risk factors, such as family history, that contribute to the disorder.

And a report on brain illness and creativity by Alice Flaherty, associate professor of neurobiology at Harvard Medical School, paints a more complicated picture. While schizophrenia is not necessarily associated with creativity, one specific traitopenness to unusual ideas—relates to creativity and is prevalent among schizophrenic patients. This trait is common in many writers, as their work is a product of their imagination.

Mental health professionals have observed the therapeutic effects of writing on patients with schizophrenia—finding that the creative process assists these individuals with managing their symptoms.

Laurie Arney, who has schizophrenia, is a case in point. Arney’s therapist Christopher Austin from the Calgary Health Region in Alberta applied an approach called Narrative Therapy to help her cope with the illness. As part of the approach, Arney wrote about her thoughts, feelings, and hallucinations in an open journal to Austin, who would then write back, asking questions about her experiences and helping her process them. He found:

“Writing helped the client to express her experience of living with a mental illness, to describe her years of mental health treatment, and to find her own path toward wellness.”

As an adjunct to other therapies, the approach was helpful for Arney. She explained:

“When I am writing, I do not censor myself the same way as when I am talking. When something stressful happens to me, I can just go to my computer. As I write to Chris about the incident, I am already starting to go through the process of dealing with it. I do not have to save up all my concerns until my next [therapy] appointment.”

Writing therapy is also supported by research from Simon Mcardle at the University of Greenwich in the United Kingdom and colleagues. Certain creative or expressive writing exercises, such as poetry and story-writing, help schizophrenic patients express themselves, and control their thoughts and hallucinations.

According to Noel Shafi, a poet and neuroscience researcher, poetry can be used as a communicative tool for schizophrenic patients to share their emotions and disturbed thoughts. Shafi explains:

“The client externalized his negative beliefs in the form of a Haiku, using poetic expression for personal awareness and growth. The client had lost his sense of self-worth through his experience with psychosis and was now using poetry to validate his existence.”

But there are some risks associated with writing therapy, as these narrative exercises can elicit negative or disturbing expressions. According to Shaun Gallagher of the University of Memphis and colleagues, when using self-narratives, such as journal accounts or stories, patients can get confused between the story and real life. One patient’s narrative account reads:

“I get all mixed up so that I don’t know myself. I feel like more than one person when this happens. I’m falling apart into bits.”

Without regular monitoring, there may be difficulties, especially if patients struggle to distinguish between their thoughts and reality. Still, as a tool in the therapist’s kit, therapeutic writing does offer some help to a number of high-risk patients with serious mental-health problems.

–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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For Mentally Ill, Jail Diversion Program Gives Second Chance

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

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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

Robert T Muller - Toronto Psychologist

Mental-Health Stigma All Too Common in Iran

70Depression, Featured news, Health, Psychopathy, Stress, Trauma March, 18

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A Minor Leap Down, an Iranian film featured at international film festivals in Berlin and Toronto, illustrates the struggle of a 30-year-old Iranian woman named Nahal, whose deteriorating mental health is undermined by her family.

When Nahal is told she’s had a miscarriage, instead of seeking support from her family—who have, in the past, refused to recognize her struggle with depression—she keeps the news to herself, leading to desperation.

Stigma surrounding psychological disorders in Iran often leads to isolation, as fear of judgment and ridicule creates barriers to pursuing treatment. Some reports show that 26.5 percent of Iranian women and 20.8 percent of Iranian men have mental-health difficulties.

In an interview with the Trauma and Mental Health Report (translated, Farsi to English), Hamed Rajabi, director of A Minor Leap Down, explains:

“This social system is only concerned with how people work and perform, and when that performance is lowered, their behavior is instantly condemned.”

Research by Ahmad Ali Noorbala and colleagues from Tehran University of Medical Sciences shows women in Iran have a greater incidence of mental disorders than women in Western cultures. One contributing factor may be that women in Iran are often confined to the home, leading to isolation and poor domestic conditions.

After the loss of her unborn child, Nahal spirals into deep depression, deciding not to remove dead fetal tissue from her womb. When she tries to address the issue with her mother and husband, she’s turned away.

Familial relationships and reputation are important aspects of Iranian culture. Mental illness in a family member is viewed as a familial flaw.

According to research published in the Journal of Health and Social Behaviour by Erin Cornwell of Cornell University and Linda Waite of the University of Chicago, social relationships are particularly important for those coping with mental illness; social withdrawal aggravates loneliness, stress, and feelings of low self-worth.

Nahal’s silence about her mental illness also relates to a worry that she’ll be forced to resume antidepressant medication, which she took prior to pregnancy. Medications like these are seen as first-line treatment in Iran.

In A Minor Leap Down, filmmaker Rajabi addresses the over-prescription of psychotropic medication in Iran, explaining:

“Depression signifies that a part of our lives hurt—and taking pills won’t solve anything until we distinguish which part of our life is causing the problem.”

Although recognition of mental-health problems in Iran has arguably increased over the past few years, considerable stigma still exists.

Awareness can translate to an enhanced understanding of the complexity of mental-health problems in a culture that holds rigid attitudes about mental health and illness.

–Nonna Khakpour, 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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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

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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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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