Category: Stress

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Jurors Are Left Traumatized by Some Court Cases

00Decision-Making, Dopamine, Empathy, Featured news, Health, Law and Crime, Post-Traumatic Stress Disorder, Stress, Trauma April, 19

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

-Copyright Robert T. Muller

This article was originally published on Psychology Today

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Pressures to Breastfeed Can Harm Maternal Mental Health

00Child Development, Decision-Making, Embarrassment, Featured news, Guilt, Health, Parenting, Postpartum, Stress, Suicide January, 19

Source: sevenfloorsdown at DeviantArt, Creative Commons

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

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

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

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

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

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

Shortly thereafter Melissa became completely overwhelmed:

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

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

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

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

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

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

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

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

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

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

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

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

-Copyright Robert T. Muller

This article was originally published on Psychology Today

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What Can A Lizard Tell Us About Mental Health?

00Animal Behavior, Child Development, Epigenetics, Evolutionary Psychology, Featured news, Genetics, Health, Parenting, Stress, Trauma December, 18

Source: Hayke Tjemmes at flickr, Creative Commons

A new study on lizards has found that, when exposed to stress, their responses can be passed down genetically. Scientists now believe there may be more to the process of heritability than once thought. This process is called “Transgenerational Stress Inheritance.”

As recently as 2011, most research did not examine the possibility that parental stress could affect sperm or egg cells. Since genes are transferred to offspring through these cells, anything that modifies them can have an impact on genetic expression in children. The idea that parents’ experiences prior to pregnancy can change gene expression and, therefore, affect offspring behaviour, is novel.

In the lizard study, researchers from Pennsylvania State University exposed young lizards to fire ants (a natural stressor) and compared stress levels to unexposed lizards. Interestingly, contact with the stressor did not affect the lizards’ behaviour later in life. But, their offspring had stronger stress reactions than offspring of lizards who had not been subjected to the ants.

Lead researcher Gail McCormick told PsyPost:

“Our work reveals that the stress experienced by an individual’s parents or ancestors may overshadow the stress that an individual faces within its lifetime. In this study, offspring of lizards from high-stress sites were more responsive to stress as adults, regardless of exposure to stress during their own lifetime.”

These findings suggest that, although early life stress may not manifest later in adulthood, the effects may be passed down to offspring, even if offspring are not directly exposed to the stressor.

A similar study involved researchers conditioning mice to associate the smell of cherries with a mild electric current. When the fragrance permeated the air, the mice were given a small electric shock. And so, the mice began to fear the scent even when the shock wasn’t administered. Even more fascinating was that offspring of these mice, as well as their offspring, experienced fear in the presence of the odor. The fear reaction occurred even though the later generations didn’t experience the conditioning process.

Of course, the question these studies pose is whether there is a similar effect in humans.

As recently reported in the Guardian newspaper, researchers from New York’s Mount Sinai School of Medicine compared the genes of direct descendants of Jews who were “interned in a Nazi concentration camp, witnessed or experienced torture or who had had to hide during the second world war” to the offspring of Jews living outside of Europe who were unharmed. The children of parents who experienced WWII trauma showed genetic changes and a greater risk of stress disorders. These were not present in the other children. The Guardian article stated:

“[The] new finding is [a] clear example in humans of the theory of epigenetic inheritance: the idea that environmental factors can affect the genes of your children.”

In other research, psychologist Margaret Keyes from the University of Minnesota and colleagues examined twins to determine if the behaviour of biological parents could affect offspring who were not raised by them. The study found that children of parents who smoked were more likely to be smokers, even if those children weren’t raised by the parents, and as such, did not have parental smoking behavior modeled to them. Scientists are still questioning, though, whether it’s parental behavior directly affecting these genes or a genetic predisposition to smoking being passed down for generations.

On the whole, these studies make the case that genetic changes can happen a lot faster than previously thought, within a few generations or even one generation. And, as reported in Science magazine, people can see evolution in real time:

“Now, thanks to the genomic revolution, researchers can actually track the population-level genetic shifts that mark evolution in action—and they’re doing this in humans. [Studies] show how our genomes have changed over centuries or decades…”

Research in this field is still new and is subject to several caveats. Perhaps the most important one is the complexity of human beings and their environments. Indeed, there may be too many variables that factor into the human experience for researchers to arrive at definitive conclusions.

But, these studies do suggest that individuals may be affected by the stress felt by ancestors in  before them. Further research is required to determine whether these findings are the result of transgenerational stress inheritance or an external factor that has yet to be considered.

– Andrei Nistor, 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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Feeling Like a Fraud in the Face of Success

00Anxiety, Confidence, Featured news, Parenting, Self-Esteem, Stress, Work June, 18

Source: Kynan Tait at flickr, Creative Commons

More common than once thought, from new fathers to high-level executives, many of us experience impostor syndrome. Defined in the Harvard Business Review, it’s:

“A collection of feelings of inadequacy that persist despite evident success. ‘Impostors’ suffer from chronic self-doubt and a sense of intellectual fraudulence that override any feelings of success or external proof of their competence.”

For fathers, these beliefs can result from observing the immediate bond between mother and infant (fathers may take up to two months to have a similar connection). Physician Liji Thomas explained to News Medical:

“Fathers bond to their babies over a longer period… During this time, they may feel ‘out of it’, especially when they observe the special bond between their spouses and the new baby.”

And many mothers think they’re impostors too. Blogger Michelle Grant posted a piece in the Huffington Post titled “The Parenthood Impostor Syndrome,” where she said:

“It’s a feeling of uncertainty, of anxiousness and for me, it was the very real idea of being a fraud in those early weeks of motherhood… ‘Everyone else is better at this than me,’ I told myself.”

New parents can’t get direct feedback, so it can be difficult to know if they’re doing things correctly for the infant. Grant continued:

“When we first become parents, we are expected to carry out a role we’ve not been trained for—and we get no feedback from our babies on how well we’re doing. So, it’s no wonder if we feel out of our depth and like an impostor.”

The impostor phenomenon is not a psychological disorder, but rather a reaction to a situation where individuals struggle to settle into a role and feel as though they’re faking ownership of it. And, feeling like an impostor isn’t limited to parents.

In a research review, psychologists Jaruwan Sakulku and James Alexander reported that as many as 70% of people experience impostor syndrome at least once during their lives—exposing the magnitude of the problem. In fact, many successful professionals face impostor syndrome.

It was first identified by psychologists Pauline Clance and Suzanne Imes in 1978 when it was used to describe many high-achieving women who didn’t recognize their personal success despite exceptional academic and professional accomplishments. These perceptions may be related to whether or not women attribute their success to luck or to ability.

Women are particularly vulnerable to impostor syndrome when they believe their achievements are the result of chance. And when they engage in occupations historically held by men, such as being a university professor or member of law enforcement, women may feel they are not truly meant to be there.

Further research, though, has demonstrated that both men and women in high-earning positions or positions that are characteristically respected are susceptible to the impostor phenomenon. A Forbes article mentioned that partners at accounting firms and famous celebrities alike have felt like frauds in their positions, as though they would be uncovered for being an impostor. Actor Don Cheadle said:

“All I can see is everything I’m doing wrong that is a sham and a fraud.”

In another example, renowned author Maya Angelou recounted:

“I have written eleven books, but each time I think, ‘uh oh, they’re going to find out now. I’ve run a game on everybody, and they’re going to find me out.’”

A number of causes can  contribute to impostor syndrome. These range from perfectionist personality traits, to family pressures to succeed, to minority status. A cover story in gradPSYCH magazine of the American Psychological Association stated:

“Differing in any way from the majority of your peers—whether by race, gender, sexual orientation or some other characteristic—can fuel the sense of being a fraud.”

There are some ways to combat impostor syndrome for those struggling with its challenges. Psychiatrists Andreea Seritan and Michelle Mehta suggest that “accepting compliments graciously” and “keeping a record of positive feedback” are important to minimize its effects.

For parents who are suffering with self-doubt, the CBT Institute of Southern California advises that acknowledging the fallibility of being human is helpful to overcoming impostor syndrome, and to enjoying the positives and pitfalls of parenthood.

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

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

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Domestic Abuse Linked to Financial Crisis

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

Source: isabellaquintana at pixabay, Creative Commons

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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Unforeseen Stress When a Child Receives a Transplant

00Featured news, Guilt, Health, Post-Traumatic Stress Disorder, Stress, Trauma April, 18

Source: debowscyfoto at pixabay, Creative Commons

On April 13, 2016, Bill and Lindsay Brent received the phone call they were desperate for. Their youngest child Nathan would get the liver transplant he urgently needed. Within hours, the family from Barrie, Ontario was heading to The Hospital for Sick Children in Toronto.

By 8:00 the next morning, Nathan’s life-saving surgery was underway. Twelve hours after surgery began, the Brents’ feisty toddler emerged from surgery sedated, but holding his own, and began his road to recovery.

Twenty months earlier, Nathan was diagnosed with Alagille Syndrome, a genetic disorder affecting his liver, and severe enough that his only hope for survival was a liver transplant. But as the months passed, the situation began to look bleak. Nathan’s rare AB negative blood type greatly decreased his chances of finding a donor match.

Complicating matters further, Nathan was ineligible for the program; he required a liver from a deceased donor rather than from someone who was living. In his case, a pediatric donor would increase the odds of success, meaning that another child would have to die for Nathan to live.

And yet, despite insurmountable odds, thanks to the decision of one family, a liver was donated and Nathan survived.

Raelynn Maloney, a clinical psychologist and co-author of the book Caring for Donor Families: Before, During and After, says that the donor waiting period can be extremely stressful for families.

“Many traumas can occur during the ‘waiting period’; seeing a loved one suffer from illness without a clear outcome in sight, financial stress as families juggle care demands with work schedules, and, of course, the fear of running out of time.”

For the Brents, though, the psychological impact of their son’s traumatic journey started to surface only after the transplant was completed. Bill explains:

“Even though you are devastated when you receive the news that your child has a life-threatening illness, your need to remain focused on the outcome and to stay positive takes over. What has been shocking is the magnitude of post-transplant emotions that we’ve had to face. You’ve received a miracle, and yet, somehow, you are gripped with guilt and sorrow for the donor’s family, and an anxiety about the future that is so strong, it hinders your ability to feel good about life.”

For the couple, while they shared the same concerns for Nathan, their struggles with anxiety manifested in different ways. While Lindsay tended to ruminate and panic about the risks to Nathan post-transplant, such as illness, injury, and organ rejection, Bill reported an increase in social anxiety and was gripped with survivor’s guilt and depression. He says:

“It is very difficult for me to accept that my son needed someone to die for him to live. The donor family is in our thoughts constantly, and words cannot describe how thankful we are to them. They are our heroes.”

Maloney explains that recipient families can have a delayed reaction to the distress they experience while their loved one is on the donor list, and they are often unprepared for the rush of emotions that come after transplant.

While remaining focused on a solution, recipient families often do not allow themselves the space to grieve setbacks as they occur. Rather, they strive to maintain hopefulness while supressing the pain of the situation.

Maloney emphasizes that it may only be during recovery, when these families finally have a chance to process what they have gone through, that the traumatic grief hits.

The Brents recognized that, post-transplant, there was much more time to reflect on the enormity of what they had been through. Although grateful for Nathan’s outcome and the support of their family and friends, the Brents still faced ongoing emotional issues, all while trying to build normalcy back into their lives. Lindsay explains:

“Since Nathan has received his new liver, we no longer have access to the transplant support team that was available to us before the surgery. The medical team has moved on, the social support from the families at the hospital has been less frequent since we have returned home. In a way, Bill and I feel like we’ve lost family members, people that up until the transplant were a part of our innermost circle. In some ways, we feel left to navigate this post-transplant terrain on our own.”

Maloney acknowledges that there is an illusion held by the public that, after a transplant, all is well and life returns to normal. In reality, this is a time when transplant recipients and their families may need even more support as they try to reconcile the trauma of the illness with a hopeful and optimistic view of the future.

Now at home, Nathan continues to improve. Bill and Lindsay look forward to the time when this difficult journey will be surpassed by many happier, hopeful moments.

–Kimberley Moore, 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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Inadequate Training Increases Risk of Compassion Fatigue

70Burnout, Caregiving, Featured news, Health, Stress, Trauma, Work March, 18

Source: Pennsylvania National Guard at flickr, Creative Commons

Every afternoon, personal support worker Susan (name changed) struggled with administering medication to a particular elderly patient in the dementia ward where she worked. On one such occasion, fed up with the patient’s behaviour, Susan became so frustrated that she mumbled a profanity, reached over, and pinched the patient’s arm. With a sharp cry of pain, the patient quickly accepted the medication and Susan was able to move on.

Stories of malpractice or poor patient care like this are not as uncommon as one might imagine. Evident from media reports of negligence in hospital settings, such cases can ignite an outcry in the community and prompt questions about individuals’ suitability for caretaking roles. How could someone with a career revolving around caring for others lack empathy?

Grace, an Ontario care worker who witnessed Susan’s behavior firsthand, believes the demanding nature of the job took a physical and mental toll on her co-worker. Having worked for eight years at a residential center for dementia patients, Grace knows from experience just how mentally exhausting the work can be. In an interview with the Trauma and Mental Health Report, Grace explained:

“There’s so much to take care of with these particular patients. When it’s dinnertime, you have to make sure to clean the patient, take them to the dining room, prepare the area for them, feed them, etc. But the next thing you know, they may have soiled themselves or vomited and you have yet another thing to clean when you already have so much to do… There are times when you need to take dirty clothing or dishes from them and they refuse to give them to you or just start yelling at you.”

When faced with the same situation on a daily basis, Grace explains that it’s hard not to become exasperated:

“It can get annoying and even angering at times. It’s hard to control… I didn’t hear much from Susan when I first started working here, but then she began yelling at the patients. I do believe it’s because the stress finally got to her.”

Mental health professionals support Grace’s theory. Overworked employees who are plagued by such feelings of frustration are showing signs of Compassion Fatigue (CF).

Francoise Mathieu, CF specialist and founder of Compassion Fatigue Solutions in Kingston, Ontario, describes the condition on her organization’s website as a gradual emotional and physical exhaustion of helping professionals. While CF is sometimes used interchangeably with Vicarious Trauma (VT), there is a difference between the two. VT is a secondary form of post-traumatic stress disorder, where a worker becomes preoccupied with a specific event or patient problem. On the other hand, CF is an overall decline in the ability to empathize with others.

The American Institute of Stress also differentiates CF from ‘burnout’. With CF, the constant pressure to show compassion toward patients may wear on mental energy stores, leading workers to become emotionally blunted to people and events. Burnout is less dependent on this loss of compassion.

CF is not limited to mental health professionals. It has been shown to affect teachers, social workers, police officers, prison guards, and even lawyers who work with trauma victims. In Grace’s words:

“At first, the stories you hear and the things you see involving the patients really do follow you home. They used to make me feel depressed. Over time, that sensitivity does lessen. After being exposed to this type of thing day after day, you start to lose those feelings.”

According to CF expert Francois Mathieu, once workers begin to experience this emotional exhaustion, they may be prone to moodiness, irritability, difficulty concentrating, intrusive thoughts, feelings of hopelessness, and apathy in both workplace and personal relationships. Fran McHolm, Director of Continuing Education at the Nurses Christian Fellowship has written about how CF can lead to a decrease in general employee happiness, workplace satisfaction, and quality of patient care.

CF is not a rare condition. Results from a 2012 dissertation study by Shannon Abraham-Cook at Seton Hall University show that, out of 111 urban public school teachers in Newark, New Jersey, 90% were at high-risk for CF. In 2010, Crystal Hooper and colleagues from the AnMed Health Medical Center in South Carolina also found that 86% of emergency department nurses exhibited moderate to high levels of CF.

While CF is common in many workplaces, help for employees who are experiencing symptoms, is not readily available. In an interview with the Trauma and Mental Health Report, Isabella, an assistant teacher working with special needs children at a Toronto daycare, describes her experience:

“When we began training, the instructors only talked about how to care for the children and how to work with the different age groups. Management didn’t provide us with anything else. The only thing we can do when feeling overly stressed is go for a break.”

Grace adds that her center for dementia patients fails to directly address employee needs:

“Recently, they added cameras everywhere to prevent poor patient care, but it’s made things worse. Now we are forced to seem especially compassionate and the littlest mistake can lead to a suspension. The management doesn’t try to understand the worker’s view of things at all.”

Dan Swayze, vice president of the Center for Emergency Medicine of Western Pennsylvania, discusses several ways management can address employees’ personal needs pertaining to compassion fatigue. In an article in the Journal of Emergency Medical Services, Swayze writes about the importance of implementing policies and developing programs that can help ease the onset of CF. Teaching employees how to set professional boundaries with patients, conducting meetings to solve individual client issues as a team, and offering counselling services to stressed employees are just a few options administration can take.

And a 2015 study by researcher Patricia Potter and colleagues in the Journal of Continuing Education in Nursing argues for resilience training, a program designed to educate personnel about CF and its risk factors. Workers are taught how to employ relaxation techniques and build social support networks to cope with symptoms that arise from working with difficult populations. Staff members from a US medical center who participated in the training self-reported an increase in their empathy and overall emotional health.

Volunteer crisis hotline operator, Anabel, explains the benefits of these resources in her line of work:

“The staff at the distress center are really considerate of their volunteers. In the training they prepare you for compassion fatigue, encourage volunteers to take care of themselves, and to not take the calls home with you. They also make sure to be available to the volunteers 24/7 in case they need to debrief a call with someone. It really helps to know they’re there to talk to—often after a distressing call.”

Training and intervention programs can help safeguard against the development of compassion fatigue in care workers. But many people working in the field, like Grace and Isabella, have been thrown into care-taking roles with no consideration for the risks to their mental wellbeing. Both women have identified various ways of coping as a stopgap until they receive the assistance and support they need.

Isabella suggests taking full advantage of breaks every few hours:

“Whenever you feel overwhelmed, go for a break right away—even if it’s just to the washroom or for a coffee… When you leave and come back, you feel refreshed. I’m lucky that I live so close to my workplace that I can go home during lunch.”

Grace recommends taking a deep breath and focusing on any positive aspect of the job:

“I learn so much from the patients. Hearing their stories, you can end up getting really close to some of them. I try to listen to them when I can and when I see the positive effect that has on them, I feel very fulfilled.”

These coping mechanisms do not work for everyone, which is why early intervention is so important. While camera implementation has prevented some inappropriate conduct like Susan’s from continuing, it doesn’t address the root problem.

“There are times where I get angry,” Grace admits. “I can’t always entertain patients or be friendly. I try… but it’s so hard… I know a lot of people, like myself, are really sensitive, which is why we are so emotionally affected by this job. There’s no stress management or counselling here, but… these training programs could really help.”

For many helping professionals, compassion fatigue may be inevitable. Cases like Susan’s show that the wellbeing of individuals in caretaking roles directly influences the quality of care that patients will receive. Support in the form of training programs and other preventative measures can make a difference in the lives of these workers, and, improve patient care.

–Anjali Wisnarama, 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

Source: PakPolaris at Deviant Art, Creative Commons

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

Robert T Muller - Toronto Psychologist

Firefighters Fight Stress as First Responders

90Burnout, Featured news, Post-Traumatic Stress Disorder, Stress, Trauma, Work February, 18

We tend to think of firefighters saving lives as fires tear through homes or forest land. What many people don’t know is that firefighters are also first responders, arriving at crisis scenes even before paramedics or police officers.

Working in stressful and traumatic situations can take a toll on their mental health. Post Traumatic Stress Disorder (PTSD) and suicide rates are much higher in first responders than in most other professions. Canadian first responders experience twice the rate of PTSD compared to civilians.

Ongoing exposure to stress means that access to support is critical. But cultural and administrative barriers get in the way. Because firefighters are regarded as tough and invulnerable, many feel embarrassed to ask for help, and available programs can be difficult to navigate.

Brian (name changed for anonymity), a 30-year veteran of the fire service and a District Chief in Ontario, Canada has experienced the stressful effects of the job firsthand, and has witnessed the toll it takes on colleagues and family:

“You’re just supposed to deal with the effects of the job. The stigma is that, if you can’t handle it, you’re weak. This idea has been built into the profession.”

When Brian entered his new role as District Chief, he received very little training on how to support the well-being of those working under him. He received only a phone number to an Employee Assistance Program (EAP) to distribute to team members if they had an exceptionally stressful day. The call is left up to individual firefighters rather than to an outreach program that communicates to them directly.

Although Brian believes that firefighters can benefit from the EAP, he knows that stigma exists around making the call. So, the resource doesn’t get used.

“There have always been employee assistance programs. In all my thirty years, I’ve only seen the EAP used once or twice. For the program to work, the agency needs to call the firefighters, because firefighters don’t reach out.”

To fight this stigma, the province of Ontario has launched several initiatives, including a new radio and digital campaign created to raise awareness and reduce the hesitancy of first responders to seek support. A free online toolkit has also been developed that addresses how to cope with PTSD.

Social support is another essential component of first responders’ wellbeing. In a study published in the Journal of Occupational Health Psychology, Jasmine Huynh of Flinders University and colleagues found that support from family and friends was critical for protecting workers from burnout and for them to cope with the demands of frontline responsibilities.

Brian and his wife Sandra (name changed for anonymity) find support in each other and also through other firefighters and their families. Sandra explains that they often use humour to address the stress:

“When you go into the fire hall, there’s a lot of humour. I think we use humour to deal with the pressure, to keep going. That’s our coping mechanism. It’s also how we manage the stress as a family.”

While some programs exist to help firefighters work through their own issues, there is very little support for families of first responders. Having a loved one who is a firefighter can take a toll on the whole household.

In a study by social work professor Cheryl Regehr and a group of researchers at the University of Toronto, the authors explored how firefighters’ wives coped with the mental distress caused by their husbands’ emotionally taxing jobs. Wives handled partner stress by emotionally distancing themselves when necessary.

After thirty years, Sandra has learned to better read Brian’s emotional states, allowing her to recognize when he needs some space after a bad shift. She explains:

“If he comes home and is quiet, and not himself, I know that something is wrong. But I just let it go and let time pass, and then, eventually, I ask him about it. I can tell when it has been a rough shift. If he wants to be alone, I let him be.”

In an attempt to shield his children from the dangers of his job, Brian doesn’t discuss work much at home:

“When I was initially on the job, I talked to Sandra a lot about it, but when the kids came, I stopped. You don’t want to bring the experiences home; you don’t want the kids to worry. It’s bad enough that Sandra worries.”

Despite being proud of her husband, Sandra can’t help but feel constant fear in the back of her mind:

“I think about Brian’s safety all the time. The fear is always there. When he was first on the job, I tried not to think about it. I didn’t watch the news, and if I did, I prayed it wasn’t his fire truck at an emergency.”

To her relief, it has always been someone else’s fire truck. But that someone usually has a family at home, also worrying.

Brian and Sandra agree that more needs to be done to support frontline workers and families. At least initiatives like the media campaign and online toolkit serve as a starting point for an open dialogue surrounding the stigma of seeking help.

At the end of the day, Brian’s job is just that: a job. He says:

“People want to call us heroes. Most of the time, I don’t classify us as heroes. We do what we’re trained to do, and if we do it well, we all come home.”

–Alyssa Carvajal, Contributing Writer, The Trauma and Mental Health Report.

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

Copyright Robert T. Muller.

This article was originally published on Psychology Today

Robert T Muller - Toronto Psychologist

Parkinson’s Takes its Toll on Family Caregivers

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

–Alyssa Carvajal, Contributing Writer, The Trauma and Mental Health Report. 

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

Copyright Robert T. Muller.

This article was originally published on Psychology Today