Serious Mental Illness Blog

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Posts tagged depression

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Ted Talk: “Andrew Solomon: Depression, the secret we share” Duration:29 mins 22 secs Date: Dec 18, 2013
“The opposite of depression is not happiness, but vitality, and it was vitality that seemed to seep away from me in that moment.” In a talk equal parts eloquent and devastating, writer Andrew Solomon takes you to the darkest corners of his mind during the years he battled depression. That led him to an eye-opening journey across the world to interview others with depression — only to discover that, to his surprise, the more he talked, the more people wanted to tell their own stories. 

 


For more mental health news, Click Here to access the Serious Mental Illness Blog

Ted Talk: “Andrew Solomon: Depression, the secret we share” 
Duration:29 mins 22 secs 
Date: Dec 18, 2013

“The opposite of depression is not happiness, but vitality, and it was vitality that seemed to seep away from me in that moment.” In a talk equal parts eloquent and devastating, writer Andrew Solomon takes you to the darkest corners of his mind during the years he battled depression. That led him to an eye-opening journey across the world to interview others with depression — only to discover that, to his surprise, the more he talked, the more people wanted to tell their own stories. 

 





For more mental health news, Click Here to access the Serious Mental Illness Blog

Filed under ted ted talks depression depressed sad sadness mind body brain health healthy well wellness mental illness mental health mental illness diagnosis recovery happiness happy mood writer interview story news mental breakdown depressing major depression major depressive disorder

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Real Men Talk About Their Feelings — For Real
By Josh Rivedal, professional actor, author, playwright, speaker on suicide prevention
Posted on The Huffington Post Healthy Living
Men are willing to talk about the size of their prostate glands, or how much Viagra they’re allowed to take, but they’re still not willing to be open about their mental health.
If men want to live long, healthy and productive lives it’s absolutely crucial that the dialogue surrounding men’s mental health has to change.
I lost my father Douglas to suicide in 2009. Douglas lost his father Haakon to suicide in 1966. Each suffered from undiagnosed mental disorders and each suffered in silence because of the stigma surrounding men talking about and getting help for mental illness.
Haakon was dealing with post-traumatic stress disorder after having been shot down in Hamburg, Germany, in 1941. Douglas may have been clinically depressed for a very long time, but my mother filing for divorce was a catalyst (not the cause) for his action in taking his own life.
There’s a relatively new case study in The Journal of Men’s Health that says that men are affected tremendously by divorce. They have higher rates of alcohol and drug abuse, depression and detach themselves from personal relationships and social support.
In 2011, I had several catalysts for my own near-suicide attempt: the dissolution of a relationship with a long-term girlfriend (similar to a divorce), a lack of work, and fallout from my mother’s betrayal. I was in terrible emotional pain and unknowingly suffering from clinical depression.
Standing at the ledge of a fourth floor window, I realized I didn’t want to die. I just wanted to end my inner torment. And I needed to break the familial cycle. So I came back inside, took a risk and asked for help by calling my mother.
Over the next few months I continued to take more risks. I called old friends to tell them I needed their support. I got into therapy. And no one ever told me I was crazy, stupid or a bad person. They told me they loved me and wanted to help me.
While recovering from clinical depression, I wanted to help youth and other men like me. So I used a biographical one-man play, The Gospel According to Josh, about my foray into show business along with my father’s suicide and took it to high schools, colleges and community centers all across the U.S. and Canada. With it, I talk about the importance of mental health and suicide prevention. Most of my audiences were and still continue to be women. One of the things I’ve found is that men have a difficult time talking about and getting help for their mental health or if they’re feeling suicidal. There seems to be some societal pressure that says “You’re not a true man if you don’t have it all together, all the time.”
But I have a message for men everywhere that’s simple yet profound. There’s always hope and help out there for you. As a man who has suffered from clinical depression, I can say from personal experience that this is not a character flaw or a weakness. It doesn’t make you any less of a man. In fact, by asking for help it makes you a stronger man. It gives you a fighting chance to improve your life and become the person you want to be. Reach out to your family and friends and ask for help. Nip it in the bud before it can turn into a crisis.
And while I’m not a mental-health professional, here are several resources to where you can ask for additional help from a professional if you need it: ManTherapy.org — an interactive tool to learn about men’s mental health; MentalHealthAmerica.net — find your local chapter of Mental Health America, a place where you can find information to help you live mentally well; SuicidePreventionLifeline.org — a general crisis line where you can reach out 24/7 to speak with someone if you’re feeling suicidal.



For more mental health news, Click Here to access the Serious Mental Illness Blog

Real Men Talk About Their Feelings — For Real

By Josh Rivedal, professional actor, author, playwright, speaker on suicide prevention

Posted on The Huffington Post Healthy Living

Men are willing to talk about the size of their prostate glands, or how much Viagra they’re allowed to take, but they’re still not willing to be open about their mental health.

If men want to live long, healthy and productive lives it’s absolutely crucial that the dialogue surrounding men’s mental health has to change.

I lost my father Douglas to suicide in 2009. Douglas lost his father Haakon to suicide in 1966. Each suffered from undiagnosed mental disorders and each suffered in silence because of the stigma surrounding men talking about and getting help for mental illness.

Haakon was dealing with post-traumatic stress disorder after having been shot down in Hamburg, Germany, in 1941. Douglas may have been clinically depressed for a very long time, but my mother filing for divorce was a catalyst (not the cause) for his action in taking his own life.

There’s a relatively new case study in The Journal of Men’s Health that says that men are affected tremendously by divorce. They have higher rates of alcohol and drug abuse, depression and detach themselves from personal relationships and social support.

In 2011, I had several catalysts for my own near-suicide attempt: the dissolution of a relationship with a long-term girlfriend (similar to a divorce), a lack of work, and fallout from my mother’s betrayal. I was in terrible emotional pain and unknowingly suffering from clinical depression.

Standing at the ledge of a fourth floor window, I realized I didn’t want to die. I just wanted to end my inner torment. And I needed to break the familial cycle. So I came back inside, took a risk and asked for help by calling my mother.

Over the next few months I continued to take more risks. I called old friends to tell them I needed their support. I got into therapy. And no one ever told me I was crazy, stupid or a bad person. They told me they loved me and wanted to help me.

While recovering from clinical depression, I wanted to help youth and other men like me. So I used a biographical one-man play, The Gospel According to Josh, about my foray into show business along with my father’s suicide and took it to high schools, colleges and community centers all across the U.S. and Canada. With it, I talk about the importance of mental health and suicide prevention. Most of my audiences were and still continue to be women. One of the things I’ve found is that men have a difficult time talking about and getting help for their mental health or if they’re feeling suicidal. There seems to be some societal pressure that says “You’re not a true man if you don’t have it all together, all the time.”

But I have a message for men everywhere that’s simple yet profound. There’s always hope and help out there for you. As a man who has suffered from clinical depression, I can say from personal experience that this is not a character flaw or a weakness. It doesn’t make you any less of a man. In fact, by asking for help it makes you a stronger man. It gives you a fighting chance to improve your life and become the person you want to be. Reach out to your family and friends and ask for help. Nip it in the bud before it can turn into a crisis.

And while I’m not a mental-health professional, here are several resources to where you can ask for additional help from a professional if you need it: ManTherapy.org — an interactive tool to learn about men’s mental health; MentalHealthAmerica.net — find your local chapter of Mental Health America, a place where you can find information to help you live mentally well; SuicidePreventionLifeline.org — a general crisis line where you can reach out 24/7 to speak with someone if you’re feeling suicidal.





For more mental health news, Click Here to access the Serious Mental Illness Blog

Filed under mental health mental illness mental health illness healthy mind body brain men man masculine Josh Rivedal suicide suicidal disorder diagnosis psychology depression depressed recovery hope pain emotional major depression major depressive disorder news therapy recover help

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Creative inspiration associated with heightened risk of bipolar disorderBy Brooks Hays 
"People with bipolar disorder highly value creativity as a positive aspect of their condition," said Professor Steven Jones, co-director of Lancaster University’s Spectrum Center, a research facility dedicated to mental health studies.
For centuries, the link between artistic creativity and mental illness has been proffered by psychologists and intellectuals. But a new study suggests the association is more than just a romantic notion.
Researchers at Yale University and Lancaster University in the U.K. recently showed that a propensity for “inspiration” predicted a greater risk of bipolar disorder in survey participants.
Artists, musicians, poets and writers have long credited experiences of mania and depression with their moments creative inspiration. But those same experiences are also signs of bipolar disorder and other mental problems.
"It appears that the types of inspiration most related to bipolar vulnerability are those which are self-generated and linked with strong drive for success," explained Professor Steven Jones, co-director of Lancaster University’s Spectrum Center, a research facility dedicated to mental health studies.
“Understanding more about inspiration is important because it is a key aspect of creativity which is highly associated with mental health problems, in particular bipolar disorder,” Jones added.
Jones worked with Dr. Alyson Dodd, of Lancaster University, and Dr. June Gruber, of Yale, to complete the study on bipolar disorder and inspiration — the details of which are published in the latest issue of PLOS One.
The researchers found the correlation by surveying 835 undergraduate students. Participants were each given two surveys — one a trusted and much-used questionnaire aimed at gauging bipolar risk, the other a survey designed to ascertain the student’s feelings towards creative inspiration.
Those who placed a greater emphasis on incidents of personal inspiration were more likely to score higher on the 48-question bipolar survey, known as the Hypomanic Personality Scale.
“People with bipolar disorder highly value creativity as a positive aspect of their condition,” said Jones. “This is relevant to clinicians, as people with bipolar disorder may be unwilling to engage with treatments and therapies which compromise their creativity.”



For more mental health news, Click Here to access the Serious Mental Illness Blog

Creative inspiration associated with heightened risk of bipolar disorder
By Brooks Hays 

"People with bipolar disorder highly value creativity as a positive aspect of their condition," said Professor Steven Jones, co-director of Lancaster University’s Spectrum Center, a research facility dedicated to mental health studies.

For centuries, the link between artistic creativity and mental illness has been proffered by psychologists and intellectuals. But a new study suggests the association is more than just a romantic notion.

Researchers at Yale University and Lancaster University in the U.K. recently showed that a propensity for “inspiration” predicted a greater risk of bipolar disorder in survey participants.

Artists, musicians, poets and writers have long credited experiences of mania and depression with their moments creative inspiration. But those same experiences are also signs of bipolar disorder and other mental problems.

"It appears that the types of inspiration most related to bipolar vulnerability are those which are self-generated and linked with strong drive for success," explained Professor Steven Jones, co-director of Lancaster University’s Spectrum Center, a research facility dedicated to mental health studies.

Understanding more about inspiration is important because it is a key aspect of creativity which is highly associated with mental health problems, in particular bipolar disorder,” Jones added.

Jones worked with Dr. Alyson Dodd, of Lancaster University, and Dr. June Gruber, of Yale, to complete the study on bipolar disorder and inspiration — the details of which are published in the latest issue of PLOS One.

The researchers found the correlation by surveying 835 undergraduate students. Participants were each given two surveys — one a trusted and much-used questionnaire aimed at gauging bipolar risk, the other a survey designed to ascertain the student’s feelings towards creative inspiration.

Those who placed a greater emphasis on incidents of personal inspiration were more likely to score higher on the 48-question bipolar survey, known as the Hypomanic Personality Scale.

People with bipolar disorder highly value creativity as a positive aspect of their condition,” said Jones. “This is relevant to clinicians, as people with bipolar disorder may be unwilling to engage with treatments and therapies which compromise their creativity.”





For more mental health news, Click Here to access the Serious Mental Illness Blog

Filed under virginia woolfe woolfe bipolar bipolar disorder mania manic depression depressed diagnosis disorder mind body brain health healthy happy happiness recovery creative creativity art artist artistic painter writer author artists inspired inspiration mental

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What Does It Feel Like to Have Bipolar Disorder?By Quora ContributorThis question originally appeared on Quora.Answer by Mills Baker, in fairly successful treatment for 12-plus years:I have bipolar disorder, as does my mother and as did her mother. I am the sort of person who “seems” bipolar to people—that is my energy, creativity, instability, mercuriality, and easy gregariousness confirm many of the popularly imagined stereotypes about bipolar people.That said, I think only in their extremes are mania and depression actually unintelligible to ordinary folks. That is: At their utmost intensity, they are unlike anything a normal person ever experiences (mania is, in particular, qualitatively different at the end than any healthy mood state), but at most times, they are not at all different from the maximally intense moods everyone knows—just more so, longer-lasting, and disconnected from normative causes.
To understand what having bipolar disorder “feels like,” keep in mind the following:
First, bipolar is less about short-term mood instability than about long-term mood cycles, which can last months, years, or in rare cases even decades. (See F.M. Mondimore for more on cycles and durations.) Instability is part of it, but not the only part.
Second, the cumulative effect of these cycles on the formation of a personality is significant. After a childhood of radically changing interests and attitudes on such a timeline, one develops a certain excitability, flightiness, distractibility, or perhaps that’s just me. But this is a major part of bipolar: the personality that is shaped by a lifetime of intense, fluctuating moods.
Third, cycles grow in intensity over time. This means that at first in mania, for example, you’re simply in a great mood. Then you’re really in an extraordinarily creative, kinetic, charming mood. Then you’re the life of all parties, and you’re feeling pretty libidinous. Then you’re doing irresponsible things and fleeing a pursuing psychosis. Then you’re in psychosis, tortured by acousticovisual hallucinations, paranoia, and your own penchant for completely unacceptable reactions and behavior. This progression can take days, weeks, months, or years. The same progression tends to hold for depression.
Kay Redfield Jamison is a psychiatrist at Johns Hopkins University who suffers from, treats, and writes about bipolar disorder. About mania, she writes:

The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there, the power to captivate others a felt certainty. There are interests found in uninteresting people. Sensuality is pervasive and the desire to seduce and be seduced irresistible. Feelings of ease, intensity, power, well-being, financial omnipotence, and euphoria pervade one’s marrow. But, somewhere, this changes. The fast ideas are far too fast, and there are far too many; overwhelming confusion replaces clarity. Memory goes. Humor and absorption on friends’ faces are replaced by fear and concern. Everything previously moving with the grain is now against— you are irritable, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind. You never knew those caves were there. It will never end, for madness carves its own reality.

Mania (and hypomania, to an obviously lesser extent) are truly hard to describe; I attempted my own description of a brief manic experience here.In the blackness of myself, I could see that my thoughts were not myself at all: My self is only a nothingness that exists in a state of pure terror and hatred, and my thoughts rotate around it as debris in a tornado. My thoughts were imbecilic, disgusting, vicious, superficial, detestable, but by this point I could no longer stay with them long enough to hate them. They distracted me, but I couldn’t attend to them. I said in my mind: Oh God, oh God, oh God, nothing, nothing, nothing. Oh God, nothing, nothing. Oh God, I’m nothing, it’s nothing, there’s nothing, God, God.Periodically I would see what I assume was a phosphene, and it would transform into something real. I saw a glowing purple shape become the sun, and the sun became the blond hair I had in childhood. And I realized that I had murdered that boy, had murdered my own boyhood self, had destroyed this innocent child, and I ground my teeth to silence myself, as I wanted to scream so loud that I would tear myself apart, would explode in a bloody spray. I was sick with guilt and fear. I had nothing inside myself any longer. I felt I had betrayed myself, had orphaned myself when I needed someone most. I heard in my mind: Why did I kill him? Oh God, he needed someone, he needed someone, why did I kill him? I’ve killed him, oh God, I’ve killed him.I was seized with a desire to gain physical access to and destroy my brain, an urge I felt in childhood when I had severe headaches. I grasped my hair and attempted to pull it out; I wanted to rip my scalp over and reach into my skull and destroy my mind, scramble and tear apart this malevolent and pathetic apparatus with my fingers, rip out the guts of my who nightmare self. I couldn’t get my hair out, hated myself for it, lost the thread of this thought, and resumed my silent shrieking and sobbing.
About depression, Jamison writes in Night Falls Fast:

In its severe forms, depression paralyzes all of the otherwise vital forces that make us human, leaving instead a bleak, despairing, desperate, and deadened state… Life is bloodless, pulseless, and yet present enough to allow a suffocating horror and pain. All bearings are lost; all things are dark and drained of feeling. The slippage into futility is first gradual, then utter. Thought, which is as pervasively affected by depression as mood, is morbid, confused, and stuporous. It is also vacillating, ruminative, indecisive, and self-castigating. The body is bone-weary; there is no will; nothing is that is not an effort, and nothing at all seems worth it. Sleep is fragmented, elusive, or all-consuming. Like an unstable gas, an irritable exhaustion seeps into every crevice of thought and action.

Jamison is well-known, too, for her research on the link between bipolar disorder and creativity, which leads me to my conclusion:To know what it “feels like” is to know the qualia, the phenomenological experiences a bipolar person encounters that an unaffected person does not. I don’t think there are many of these. Going berserk, being creative, having an awful temper, not being able to trust my own emotional reactions: These have a certain weight when I list them out, discuss them as individual tragedies. They can even sound unique.But everyone loses it. Everyone has his moments of charisma, creativity, success, strength, achievement, and everyone struggles with himself. You may not hallucinate, but I bet you can understand what it’s like for your mind to misbehave, react insanely. If you haven’t yet lost control of yourself in life, wait.We bipolar people have a tendency to comfort ourselves by saying that our more intense experience of typical phenomena constitutes an election: We are elite, more alive, deeper! Jamison’s own excellent research on bipolar artists has amplified this: The popular Western conflation of insanity, artistic talent, and melodrama permits a kind of sentimental self-regard: Yes, I’m crazy, but I’m also probably in some difficult-to-establish way deeply brilliant!Perhaps this is true for some, but it seems mostly to me to be a consolatory story, the sort of inversion that Nietzsche describes as resentiment: To say this illness is really a kind of health, a kind of deeper seeing, is a lie. I like my life a lot, but I am uncomfortable with this persistent meme, largely because I’m sometimes confused into believing it myself. Indeed, one of bipolar disorder’s chief symptoms is often that a patient confuses herself with an artist. (Or more generally: an exception. Mondimore notes that throughout history, “grandiosity” has changed in its expressions. An important symptom of bipolar, grandiosity was once expressed by women saying they were pregnant with kings or the messiah, men believing they were kings or the messiah; presently, our insanity is less monarchical and religious; we all instead believe we special exceptions of one sort or another).I’ve been in treatment now for 12 years, on the same cocktail of medications for years and years. For me, the most enduring way that bipolar “feels” different is in how I cannot trust my reactions. When someone says something to you and you recognize it as an insult, as abuse, your reactive anger is appropriate and you can commit to it, or you can make some determination based on your values, your reason, and choose a different course of action. I can’t even trust that the person insulted me. I can’t trust my emotional perceptions or reactions.That’s the strangest thing about how it feels, after the dust of the actual disorder settles, more than a decade in: the open insanity has abated and visits only briefly, the idea that I’m a secret artist is absurd, and what’s left is a more or less normal life in which I have to emphasize “mental hygiene” (prioritizing regular sleep, for example) and in which I always feel doubt about what I think and feel, as we all probably should anyway.Note: As Anne Zieger helpfully noted, this answer is not fully comprehensive: Phenomena such as rapid-cycling, which I’ve experienced only from SSRIs, aren’t discussed, and the variations of bipolar disorder aren’t either. How it “feels” to be bipolar naturally varies widely from person to person, just as how it feels to be sane must, so I should emphasize that this answer is how it feels for me alone. Most bipolar people will have significant variations in their experiences.



For more mental health news, Click Here to access the Serious Mental Illness Blog

What Does It Feel Like to Have Bipolar Disorder?
By Quora Contributor

This question originally appeared on Quora.

Answer by Mills Baker, in fairly successful treatment for 12-plus years:

I have bipolar disorder, as does my mother and as did her mother. I am the sort of person who “seems” bipolar to people—that is my energy, creativity, instability, mercuriality, and easy gregariousness confirm many of the popularly imagined stereotypes about bipolar people.
That said, I think only in their extremes are mania and depression actually unintelligible to ordinary folks. That is: At their utmost intensity, they are unlike anything a normal person ever experiences (mania is, in particular, qualitatively different at the end than any healthy mood state), but at most times, they are not at all different from the maximally intense moods everyone knows—just more so, longer-lasting, and disconnected from normative causes.

To understand what having bipolar disorder “feels like,” keep in mind the following:

  • First, bipolar is less about short-term mood instability than about long-term mood cycles, which can last months, years, or in rare cases even decades. (See F.M. Mondimore for more on cycles and durations.) Instability is part of it, but not the only part.
  • Second, the cumulative effect of these cycles on the formation of a personality is significant. After a childhood of radically changing interests and attitudes on such a timeline, one develops a certain excitability, flightiness, distractibility, or perhaps that’s just me. But this is a major part of bipolar: the personality that is shaped by a lifetime of intense, fluctuating moods.
  • Third, cycles grow in intensity over time. This means that at first in mania, for example, you’re simply in a great mood. Then you’re really in an extraordinarily creative, kinetic, charming mood. Then you’re the life of all parties, and you’re feeling pretty libidinous. Then you’re doing irresponsible things and fleeing a pursuing psychosis. Then you’re in psychosis, tortured by acousticovisual hallucinations, paranoia, and your own penchant for completely unacceptable reactions and behavior. This progression can take days, weeks, months, or years. The same progression tends to hold for depression.


Kay Redfield Jamison is a psychiatrist at Johns Hopkins University who suffers from, treats, and writes about bipolar disorder. About mania, she writes:

The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there, the power to captivate others a felt certainty. There are interests found in uninteresting people. Sensuality is pervasive and the desire to seduce and be seduced irresistible. Feelings of ease, intensity, power, well-being, financial omnipotence, and euphoria pervade one’s marrow. But, somewhere, this changes. The fast ideas are far too fast, and there are far too many; overwhelming confusion replaces clarity. Memory goes. Humor and absorption on friends’ faces are replaced by fear and concern. Everything previously moving with the grain is now against— you are irritable, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind. You never knew those caves were there. It will never end, for madness carves its own reality.

Mania (and hypomania, to an obviously lesser extent) are truly hard to describe; I attempted my own description of a brief manic experience here.
In the blackness of myself, I could see that my thoughts were not myself at all: My self is only a nothingness that exists in a state of pure terror and hatred, and my thoughts rotate around it as debris in a tornado. My thoughts were imbecilic, disgusting, vicious, superficial, detestable, but by this point I could no longer stay with them long enough to hate them. They distracted me, but I couldn’t attend to them. I said in my mind: Oh God, oh God, oh God, nothing, nothing, nothing. Oh God, nothing, nothing. Oh God, I’m nothing, it’s nothing, there’s nothing, God, God.
Periodically I would see what I assume was a phosphene, and it would transform into something real. I saw a glowing purple shape become the sun, and the sun became the blond hair I had in childhood. And I realized that I had murdered that boy, had murdered my own boyhood self, had destroyed this innocent child, and I ground my teeth to silence myself, as I wanted to scream so loud that I would tear myself apart, would explode in a bloody spray. I was sick with guilt and fear. I had nothing inside myself any longer. I felt I had betrayed myself, had orphaned myself when I needed someone most. I heard in my mind: Why did I kill him? Oh God, he needed someone, he needed someone, why did I kill him? I’ve killed him, oh God, I’ve killed him.
I was seized with a desire to gain physical access to and destroy my brain, an urge I felt in childhood when I had severe headaches. I grasped my hair and attempted to pull it out; I wanted to rip my scalp over and reach into my skull and destroy my mind, scramble and tear apart this malevolent and pathetic apparatus with my fingers, rip out the guts of my who nightmare self. I couldn’t get my hair out, hated myself for it, lost the thread of this thought, and resumed my silent shrieking and sobbing.

About depression, Jamison writes in Night Falls Fast:

In its severe forms, depression paralyzes all of the otherwise vital forces that make us human, leaving instead a bleak, despairing, desperate, and deadened state… Life is bloodless, pulseless, and yet present enough to allow a suffocating horror and pain. All bearings are lost; all things are dark and drained of feeling. The slippage into futility is first gradual, then utter. Thought, which is as pervasively affected by depression as mood, is morbid, confused, and stuporous. It is also vacillating, ruminative, indecisive, and self-castigating. The body is bone-weary; there is no will; nothing is that is not an effort, and nothing at all seems worth it. Sleep is fragmented, elusive, or all-consuming. Like an unstable gas, an irritable exhaustion seeps into every crevice of thought and action.


Jamison is well-known, too, for her research on the link between bipolar disorder and creativity, which leads me to my conclusion:
To know what it “feels like” is to know the qualia, the phenomenological experiences a bipolar person encounters that an unaffected person does not. I don’t think there are many of these. Going berserk, being creative, having an awful temper, not being able to trust my own emotional reactions: These have a certain weight when I list them out, discuss them as individual tragedies. They can even sound unique.
But everyone loses it. Everyone has his moments of charisma, creativity, success, strength, achievement, and everyone struggles with himself. You may not hallucinate, but I bet you can understand what it’s like for your mind to misbehave, react insanely. If you haven’t yet lost control of yourself in life, wait.
We bipolar people have a tendency to comfort ourselves by saying that our more intense experience of typical phenomena constitutes an election: We are elite, more alive, deeper! Jamison’s own excellent research on bipolar artists has amplified this: The popular Western conflation of insanity, artistic talent, and melodrama permits a kind of sentimental self-regard: Yes, I’m crazy, but I’m also probably in some difficult-to-establish way deeply brilliant!
Perhaps this is true for some, but it seems mostly to me to be a consolatory story, the sort of inversion that Nietzsche describes as resentiment: To say this illness is really a kind of health, a kind of deeper seeing, is a lie. I like my life a lot, but I am uncomfortable with this persistent meme, largely because I’m sometimes confused into believing it myself. Indeed, one of bipolar disorder’s chief symptoms is often that a patient confuses herself with an artist. (Or more generally: an exception. Mondimore notes that throughout history, “grandiosity” has changed in its expressions. An important symptom of bipolar, grandiosity was once expressed by women saying they were pregnant with kings or the messiah, men believing they were kings or the messiah; presently, our insanity is less monarchical and religious; we all instead believe we special exceptions of one sort or another).
I’ve been in treatment now for 12 years, on the same cocktail of medications for years and years. For me, the most enduring way that bipolar “feels” different is in how I cannot trust my reactions. When someone says something to you and you recognize it as an insult, as abuse, your reactive anger is appropriate and you can commit to it, or you can make some determination based on your values, your reason, and choose a different course of action. I can’t even trust that the person insulted me. I can’t trust my emotional perceptions or reactions.
That’s the strangest thing about how it feels, after the dust of the actual disorder settles, more than a decade in: the open insanity has abated and visits only briefly, the idea that I’m a secret artist is absurd, and what’s left is a more or less normal life in which I have to emphasize “mental hygiene” (prioritizing regular sleep, for example) and in which I always feel doubt about what I think and feel, as we all probably should anyway.

Note: As Anne Zieger helpfully noted, this answer is not fully comprehensive: Phenomena such as rapid-cycling, which I’ve experienced only from SSRIs, aren’t discussed, and the variations of bipolar disorder aren’t either. How it “feels” to be bipolar naturally varies widely from person to person, just as how it feels to be sane must, so I should emphasize that this answer is how it feels for me alone. Most bipolar people will have significant variations in their experiences.





For more mental health news, Click Here to access the Serious Mental Illness Blog

Filed under bipolar bipolar disorder bi polar disorder diagnosis mind body brain health healthy mental mental illness illness mental health mania manic depression depressed sad emotion feelings feeling psychology psychiatry counseling therapy treatment recovery hope quora

124 notes

Interview: Borderline Personality Disorder, Fear Of Abandonment, And RelationshipsBy Richard Zwolinski, LMHC, Casac & C.R. ZwolinskiToday we’re talking with therapist Lisa Bahar about Borderline Personality Disorder and how it can affect relationships.Welcome, Lisa. BPD makes it difficult to be involved in a stable, healthy relationship. What are some kinds of behaviors that people with BPD have that are a challenge to a relationship?A person with BPD desires and responds to structure, predictability and communication. When there is lack of predictability, anxiety or fear of abandonment can potentially set in, and disruptive and unstable behavior can escalate into controlling and aggressive reactions.These reactions can occur when their partner’s behavior even slightly differs from what is expected. For example, if a partner, who is “always” on time is 15 minutes late, breaking a pattern of predictability, feeling of anxiousness increase. These feelings trigger feelings of abandonment, which can then lead to disproportionate reactions. These feelings are all rooted in fear.For example, when the partner shows up, the person with BPD might accuse them of cheating, leaving or have a plan to leave them. Or the person with BPD might act out with behaviors used as a way to give the message that the other is being “punished”. These might include not speaking, slamming doors, pouting, and so on. They all communicate I am angry.Tell us more about what this type of manipulative behavior looks like?Manipulation is a way to create control. If it is unconsciously motivated through a conscious act, such as an outward behavior like tantrums, crying, threatening, and attacking, it is what I call sloppy manipulation.Or, it can be sophisticated manipulation. When manipulative behavior takes the form of crafty questions which are intended to trap the other person into saying something that they really did not know mean to say, or give an answer that they really didn’t realize they were giving.The individual with BPD does not always use direct and healthy communication skills and instead acts out behaviorally and/or communicates indirectly.Are people with BPD consciously manipulating others? Sometimes, it seems like these manipulative behaviors are habits or knee jerk reactions rather than conscious emotional manipulation. Can you explain what is really going on?Exactly, these behaviors can be habits. Generally until awareness sets in, the individual may not know that they are unconsciously motivated. Once awareness sets in, and insight is gained, usually through various mindfulness practices, then there can be an opportunity for behavior change.Behavioral change is the real test of insight. Of course, the individual with BPD needs to actually know how to change and that is where the Dialectical Behavior Therapy skills become helpful.What are the underlying reasons and/or mechanisms driving manipulative behavior in someone with BPD?Fear of abandonment. Also, a feeling of disconnect particularly with a sense of self. This happens when an individual feels they don’t have an identity without the other there to define them. When the partner demonstrates behaviors that are interpreted as “leaving” by an individual with BPD it can feel like a loss of identity.Fear of abandonment can feel almost like death to the individual with BPD since it is a kind of “death of self.” That is why some people with BPD have a pattern of jumping from relationship to relationship—they do this in order to sustain sense of self.How does Dialectical Behavior Therapy help those with BPD resolve these issues?Dialectical Behavior Therapy is a set of skills that are very concrete and clear. They allow the individual to decrease emotionally intense reactions by providing a way to decrease the symptoms.DBT teaches a set of skills including:Core Mindfulness skills which help to calm the mind.Interpersonal Effectiveness skills which are designed to help you effectively communicate what you want, express feelings and say no clearly.Emotional Regulation skills which help you manage and deal with emotions rather than emotions controlling you.Distress Tolerance skills which help you be able to handle crisis situations more effectively and deal with reality and it’s terms, as opposed to resisting what reality is.What are some suggestions for people who want to overcome manipulative behaviors that drive people away?The first part is that the person has to want the change—they have to be the one to do the work! Of course, someone else such as the person the client is in a relationship might also want the change, and that is fine—but it can’t be the primary motivation.Next, there must be a willingness and dedication to learning skills that can help. For example the client must be willing to practice the skills he or she learns from DBT. They have to understand: This is a not a quick fix, but the development of a pattern of life skills.What advice do you have for family, friends and colleagues who are trying to cope with these behaviors and who, understandably, don’t want to feel attacked or manipulated?Education is key.Significant others must be aware of their part in interactions and reactions and must learn how best to respond. DBT is most effective if all family members are involved. Each person involved should practice a self care plan. It is so important for clients and family members to not point the finger at any one person.Thanks for speaking to this topic.


For more mental health news, Click Here to access the Serious Mental Illness Blog

Interview: Borderline Personality Disorder, Fear Of Abandonment, And Relationships
By Richard Zwolinski, LMHC, Casac & C.R. Zwolinski

Today we’re talking with therapist Lisa Bahar about Borderline Personality Disorder and how it can affect relationships.

Welcome, Lisa. BPD makes it difficult to be involved in a stable, healthy relationship. What are some kinds of behaviors that people with BPD have that are a challenge to a relationship?
A person with BPD desires and responds to structure, predictability and communication. When there is lack of predictability, anxiety or fear of abandonment can potentially set in, and disruptive and unstable behavior can escalate into controlling and aggressive reactions.
These reactions can occur when their partner’s behavior even slightly differs from what is expected. For example, if a partner, who is “always” on time is 15 minutes late, breaking a pattern of predictability, feeling of anxiousness increase. These feelings trigger feelings of abandonment, which can then lead to disproportionate reactions. These feelings are all rooted in fear.
For example, when the partner shows up, the person with BPD might accuse them of cheating, leaving or have a plan to leave them. Or the person with BPD might act out with behaviors used as a way to give the message that the other is being “punished”. These might include not speaking, slamming doors, pouting, and so on. They all communicate I am angry.

Tell us more about what this type of manipulative behavior looks like?
Manipulation is a way to create control. If it is unconsciously motivated through a conscious act, such as an outward behavior like tantrums, crying, threatening, and attacking, it is what I call sloppy manipulation.
Or, it can be sophisticated manipulation. When manipulative behavior takes the form of crafty questions which are intended to trap the other person into saying something that they really did not know mean to say, or give an answer that they really didn’t realize they were giving.
The individual with BPD does not always use direct and healthy communication skills and instead acts out behaviorally and/or communicates indirectly.

Are people with BPD consciously manipulating others? Sometimes, it seems like these manipulative behaviors are habits or knee jerk reactions rather than conscious emotional manipulation. Can you explain what is really going on?
Exactly, these behaviors can be habits. Generally until awareness sets in, the individual may not know that they are unconsciously motivated. Once awareness sets in, and insight is gained, usually through various mindfulness practices, then there can be an opportunity for behavior change.
Behavioral change is the real test of insight. Of course, the individual with BPD needs to actually know how to change and that is where the Dialectical Behavior Therapy skills become helpful.

What are the underlying reasons and/or mechanisms driving manipulative behavior in someone with BPD?
Fear of abandonment. Also, a feeling of disconnect particularly with a sense of self. This happens when an individual feels they don’t have an identity without the other there to define them. When the partner demonstrates behaviors that are interpreted as “leaving” by an individual with BPD it can feel like a loss of identity.
Fear of abandonment can feel almost like death to the individual with BPD since it is a kind of “death of self.” That is why some people with BPD have a pattern of jumping from relationship to relationship—they do this in order to sustain sense of self.

How does Dialectical Behavior Therapy help those with BPD resolve these issues?
Dialectical Behavior Therapy is a set of skills that are very concrete and clear. They allow the individual to decrease emotionally intense reactions by providing a way to decrease the symptoms.
DBT teaches a set of skills including:
Core Mindfulness skills which help to calm the mind.
Interpersonal Effectiveness skills which are designed to help you effectively communicate what you want, express feelings and say no clearly.
Emotional Regulation skills which help you manage and deal with emotions rather than emotions controlling you.
Distress Tolerance skills which help you be able to handle crisis situations more effectively and deal with reality and it’s terms, as opposed to resisting what reality is.

What are some suggestions for people who want to overcome manipulative behaviors that drive people away?
The first part is that the person has to want the change—they have to be the one to do the work! Of course, someone else such as the person the client is in a relationship might also want the change, and that is fine—but it can’t be the primary motivation.
Next, there must be a willingness and dedication to learning skills that can help. For example the client must be willing to practice the skills he or she learns from DBT. They have to understand: This is a not a quick fix, but the development of a pattern of life skills.

What advice do you have for family, friends and colleagues who are trying to cope with these behaviors and who, understandably, don’t want to feel attacked or manipulated?
Education is key.
Significant others must be aware of their part in interactions and reactions and must learn how best to respond. DBT is most effective if all family members are involved. Each person involved should practice a self care plan. It is so important for clients and family members to not point the finger at any one person.

Thanks for speaking to this topic.





For more mental health news, Click Here to access the Serious Mental Illness Blog

Filed under bpd borderline borderline personality borderline personality disorder personality disorder personality disorder recovery education news research psychology psychiatry therapy sad sadness depression dsm character cbt cognitive cognitive behavioral cognitive behavioral therapy behavioral behavior brain mind body mental health mental illness

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For Depression, Prescribing Exercise Before MedicationBy Olga KhazanAerobic activity has shown to be an effective treatment for many forms of depression. So why are so many people still on antidepressants?Joel Ginsberg was a sophomore at a college in Dallas when the social anxiety he had felt throughout his life morphed into an all-consuming hopelessness. He struggled to get out of bed, and even the simplest tasks felt herculean.“The world lost its color,” he told me. “Nothing interested me; I didn’t have any motivation. There was a lot of self-doubt.”He thought getting some exercise might help, but it was hard to motivate himself to go to the campus gym.“So what I did is break it down into mini-steps,” he said. “I would think about just getting to the gym, rather than going for 30 minutes. Once I was at the gym, I would say, ‘I’m just going to get on the treadmill for five minutes.’”Eventually, he found himself reading novels for long stretches at a time while pedaling away on a stationary bike. Soon, his gym visits became daily. If he skipped one day, his mood would plummet the next.“It was kind of like a boost,” he said, recalling how exercise helped him break out of his inertia. “It was a shift in mindset that kind of got me over the hump.”Depression is the most common mental illness—affecting a staggering 25 percent of Americans—but a growing body of research suggests that one of its best cures is cheap and ubiquitous. In 1999, a randomized controlled trial showed that depressed adults who took part in aerobic exercise improved as much as those treated with Zoloft. A 2006 meta-analysis of 11 studies bolstered those findings and recommended that physicians counsel their depressed patients to try it. A 2011 study took this conclusion even further: It looked at 127 depressed people who hadn’t experienced relief from SSRIs, a common type of antidepressant, and found that exercise led 30 percent of them into remission—a result that was as good as, or better than, drugs alone.Though we don’t know exactly how any antidepressant works, we think exercise combats depression by enhancing endorphins: natural chemicals that act like morphine and other painkillers. There’s also a theory that aerobic activity boosts norepinephrine, a neurotransmitter that plays a role in mood. And like antidepressants, exercise helps the brain grow new neurons.But this powerful, non-drug treatment hasn’t yet become a mainstream remedy. In a 2009 study, only 40 percent of depressed patients reported being counseled to try exercise at their last physician visit.Instead, Americans are awash in pills. The use of antidepressants has increased 400 percent between 1988 and 2008. They’re now one of the three most-prescribed categories of drugs, coming in right after painkillers and cholesterol medications.After 15 years of research on the depression-relieving effects of exercise, why are there still so many people on pills? The answer speaks volumes about our mental-health infrastructure and physician reimbursement system, as well as about how difficult it remains to decipher the nature of depression and what patients want from their doctors.Jogging as medicine“I am only a doctor, not a dictator,” insists Madhukar H. Trivedi, a professor of psychiatry at the University of Texas Southwestern Medical Center in Dallas. “I don’t tell patients what to do.”Trivedi is one of the forefathers of the movement to combat melancholy with physical exertion. He’s authored multiple studies on the exercise-depression connection, and workouts are now one of the many weapons in his psychiatric arsenal. But whether any given treatment is right for a particular person is entirely up to that patient, he said.“I talk about the pros and cons about all the treatment options available—exercise, therapy, and pills,” he said. “If a patient says, ‘I’m not really keen on medication and therapy, I want to use exercise,’ then if it’s appropriate, they can try it. But I give them caveats about how they should be monitoring it. I don’t say, ‘Go exercise and call me if it doesn’t work.’”Here’s how he goes about this unconventional type of prescription:“People will take the disease and treatment lightly if they know Paxil is coming.First, Trivedi must gently raise the idea of exercise as a treatment option—patients often don’t know to ask. (There are no televised pharmaceutical ads for running, he notes.) He then tells patients about the studies, the amount of exercise that would be required, and the heart rate they’d need to reach. Based on a recent study by Trivedi and others, he recommends three to five sessions per week. Each one should last 45 to 60 minutes, and patients should reach 50 to 85 percent of their maximum heart rates.He and the patient then blueprint a weekly workout schedule together. Not doing enough sessions, he warns, would be like a diabetic person “using insulin only occasionally.” He encourages patients to use FitBits or other monitoring gadgets to track their progress—and to guilt them off the couch.Trivedi says this approach rests on three key elements. “One, you have to be very clear with patients that just because exercise has been shown to be efficacious, it doesn’t work for everyone. Two, the dose of the treatment is very important; you can’t just go for a stroll in the park. And three, there has to be a constant vigilance about the monitoring of symptoms. If the treatment is not working, you need to do something.”That “something” could be adding antidepressants back into the mix—but only if the workouts have truly failed.“People will take the disease and treatment lightly,” he said, “if they know Paxil is coming.”The insurance challengeWhen it comes to non-drug remedies for depression, exercise is actually just one of several promising options. Over the past few months, research has shown that other common lifestyle adjustments, like meditating or getting more sleep, might also relieve symptoms. Therapy has been shown to work just as well as SSRIs and other medications. In fact, a major JAMA study a few years ago cast doubt on the effectiveness of antidepressants in general, finding that the drugs don’t function any better than placebo pills for people with mild or moderate depression.The half-dozen psychiatrists I interviewed said they’ve started to incorporate non-drug treatments into their plans for depressed patients. But they said they’re only able to do that because they don’t accept insurance. (One of the doctors works for a college system and only sees students.)That’s because insurers still largely reimburse psychiatrists, like all other doctors, for each appointment—whatever that appointment may entail—rather than for curing a given patient. It takes less time to write a prescription for Zoloft than it does to tease out a patient’s options for sleeping better and breaking a sweat. Fewer moments spent mapping out jogging routes or sleep schedules means being able to squeeze in more patients for medications each day.“[Psychiatrists] can probably do four medication-management visits in an hour,” said Chuck Ingoglia, a senior vice president at the National Council for Behavioral Health. “If they were doing therapy, they might see one person for 50 minutes.”An insurance company might pay an internist and a psychiatrist both $100 for an appointment, but a primary care check-up might take 15 minutes while a thorough conversation with a psychiatrist takes 40 or more.Because of these constraints, psychiatrists are among the least likely specialists to accept insurance—only about 55 percent of them do. Henry David Abraham, a psychiatrist in Lexington, Massachusetts, said he stopped accepting insurance once he realized his patient visits were becoming too rushed.“I was seeing patients for 15 minutes each to give them drugs,” he said. “What would my mentors say about that quality of care? They would say, ‘Horrible!’”He now sees patients on a sliding scale, with the wealthy essentially footing the bill for the poor. His sessions include a range of treatment options, including therapy.“One patient lost a husband to cancer, and medication may take the edge off of some of those emotions, but the process she requires is to work through the elements of grief,” he said. “There’s not a pill for that.”Meanwhile, psychiatrists who take insurance are increasingly less likely to offer talk therapy—or longer appointments of any kind—because licensed social workers and psychologists can offer the same types of sessions at lower rates.“If you’re an insurance company, and you can get a social worker to do therapy for $50, that becomes the floor,” Ingoglia said.When Brittany, a woman who lives in northern Virginia, first began experiencing panic attacks a few months ago, she turned to a series of providers in her insurance network. None of the doctors she saw wanted to discuss anything but drug options, she said.“They were all just throwing medication at me,” she said. (She asked that I not use her last name). “I said I don’t want medicine, but they didn’t want to talk about a long-term therapeutic plan.”She went through eight different providers before finally finding a psychiatrist who helped her establish a plan to do yoga several times a week to manage her panic disorder. Those psychiatrist appointments are 90 minutes long.Exacerbating all of this is the fact that there’s a shortage of psychiatrists, and the needs of people with mental health issues are increasingly being addressed by primary-care doctors, who now provide over a third of all mental health-care in the U.S. Sixty-two percent of all antidepressant prescriptions are now written by general practitioners, ob-gyns, and pediatricians.But general practitioners aren’t always as equipped as psychiatrists to diagnose and treat depression. In 2007, 73 percent of patients who were prescribed an antidepressant were not given psychiatric diagnoses. In other cases, primary care doctors may balk at the idea of prescribing any interventions because they don’t feel they know enough about depression.Writing in The New Yorker last year, primary care internist Suzanne Koven said she’s often at a loss when faced with “the lawyer who’s having trouble meeting deadlines and wants medication for attention-deficit disorder. Or the businesswoman whose therapist told her to see me about starting an antidepressant.”She feared she lacked “the time or training to diagnose and manage many psychiatric disorders,” she wrote.Managing life’s roadblocksLet’s say you’re a psychiatrist who has managed to start incorporating sleep, exercise, and other non-drug remedies into a patient’s depression treatment. Congratulations! You now face a patient who is, very possibly, lethargic, unsatisfied, and lying about how many times he or she went running last week.That is, if you can convince the patient to try anything other than drugs in the first place.Julia Samton, a psychiatrist who practices in New York City, said she prescribes medications as a “third-tier resort” after lifestyle changes and therapy have been ruled out. She spends 45 minutes on each appointment, attempting to punch through her patients’ stony Manhattanite exteriors and expose the foundations of their agony.“There are some people who say all they want is medication,” she said. “But they are the ones who are suffering tremendously and have a difficult time accessing their mental life. They want things fixed, and fixed right now.”She said some of her patients are lured by the drug ads they see on TV— charming little spots that make it look like a gloomy day is nothing an SSRI can’t handle.“It’s evocative to see a commercial where your world could change from black and white to color,” she said.Beth Salcedo is a psychiatrist near Washington, D.C. People in this perpetual type-A convention of a town tend to have too much work, too-lofty aspirations, too high a rent, and too little time left before their evening networking event starts.“I think it’s difficult to convince people to spend half an hour a day on exercise when they have kids, a job, and it can take months to see the benefit,” she said.Some patients claim they can’t make time for the gym, or are adamant that they can’t afford to sleep more than six hours each night. And lawyers who work 16-hour days are not going to sit through long counseling appointments no matter how many peer-reviewed studies you wave at them.“What do you do? Do you let them walk around depressed?” Salcedo said. “Or do you offer them a treatment that they’ll accept? Everyone has to do the thing that works for them.”And despite its merits, exercise is not nearly as portable or painless as a tablet.Salcedo had one patient whose mood entirely depended on her workouts. The hitch was that her exercise of choice was swimming—and the only pool she had access to was outdoors. “In the spring, fall, and winter, it wasn’t so easy,” Salcedo said.Depressed patients are also more likely than most to feel unmotivated, so even the best-laid exercise treatment plan can be thwarted by a few days of staying in bed for an extra hour.“Depressed patients have apathy or a lack of energy. Or they have anxiety disorders so they’re not going to go to the gym. Or they’re afraid to be seen jogging across Monument Avenue,” said Joan Plotkin Han, a staff psychiatrist at Virginia Commonwealth University in Richmond. Still, she pushes it with her more intrepid patients. “I don’t want to be that intimidating or threatening, but I’m a nag. And I will nag them.”Of course, sometimes exercise works as a multiplier, augmenting the effectiveness of an existing treatment, including drugs or therapy, or simply by helping the patient regain agency in their lives. Many patients recover from depression faster when the disease is attacked through multiple approaches simultaneously.Ginsberg said exercise didn’t cure him, but it did give him the energy to sort through the origins of his inner turmoil. And Brittany did eventually go on SSRIs to halt her nightly panic attacks—but now that yoga has her anxiety under control, she’s tapering off the drugs once again.Exercise, like any other treatment, won’t work for every depressed patient. But the psychiatrists who incorporate it into their practices are finding that the only way it can work is if it’s treated like real medicine.“The issue is that exercise seems as straightforward and simple as apple pie and your mom,” Trivedi said. “Everybody knows what it is, so it’s misunderstood. It’s important to explain to patients the seriousness of the disease they have and the nuances of the intervention they need.”


For more mental health news, Click Here to access the Serious Mental Illness Blog

For Depression, Prescribing Exercise Before Medication
By Olga Khazan

Aerobic activity has shown to be an effective treatment for many forms of depression. So why are so many people still on antidepressants?

Joel Ginsberg was a sophomore at a college in Dallas when the social anxiety he had felt throughout his life morphed into an all-consuming hopelessness. He struggled to get out of bed, and even the simplest tasks felt herculean.
“The world lost its color,” he told me. “Nothing interested me; I didn’t have any motivation. There was a lot of self-doubt.”
He thought getting some exercise might help, but it was hard to motivate himself to go to the campus gym.
“So what I did is break it down into mini-steps,” he said. “I would think about just getting to the gym, rather than going for 30 minutes. Once I was at the gym, I would say, ‘I’m just going to get on the treadmill for five minutes.’”
Eventually, he found himself reading novels for long stretches at a time while pedaling away on a stationary bike. Soon, his gym visits became daily. If he skipped one day, his mood would plummet the next.
“It was kind of like a boost,” he said, recalling how exercise helped him break out of his inertia. “It was a shift in mindset that kind of got me over the hump.”
Depression is the most common mental illness—affecting a staggering 25 percent of Americans—but a growing body of research suggests that one of its best cures is cheap and ubiquitous. In 1999, a randomized controlled trial showed that depressed adults who took part in aerobic exercise improved as much as those treated with Zoloft. A 2006 meta-analysis of 11 studies bolstered those findings and recommended that physicians counsel their depressed patients to try it. A 2011 study took this conclusion even further: It looked at 127 depressed people who hadn’t experienced relief from SSRIs, a common type of antidepressant, and found that exercise led 30 percent of them into remission—a result that was as good as, or better than, drugs alone.
Though we don’t know exactly how any antidepressant works, we think exercise combats depression by enhancing endorphins: natural chemicals that act like morphine and other painkillers. There’s also a theory that aerobic activity boosts norepinephrine, a neurotransmitter that plays a role in mood. And like antidepressants, exercise helps the brain grow new neurons.
But this powerful, non-drug treatment hasn’t yet become a mainstream remedy. In a 2009 study, only 40 percent of depressed patients reported being counseled to try exercise at their last physician visit.
Instead, Americans are awash in pills. The use of antidepressants has increased 400 percent between 1988 and 2008. They’re now one of the three most-prescribed categories of drugs, coming in right after painkillers and cholesterol medications.
After 15 years of research on the depression-relieving effects of exercise, why are there still so many people on pills? The answer speaks volumes about our mental-health infrastructure and physician reimbursement system, as well as about how difficult it remains to decipher the nature of depression and what patients want from their doctors.

Jogging as medicine
“I am only a doctor, not a dictator,” insists Madhukar H. Trivedi, a professor of psychiatry at the University of Texas Southwestern Medical Center in Dallas. “I don’t tell patients what to do.”
Trivedi is one of the forefathers of the movement to combat melancholy with physical exertion. He’s authored multiple studies on the exercise-depression connection, and workouts are now one of the many weapons in his psychiatric arsenal. But whether any given treatment is right for a particular person is entirely up to that patient, he said.
“I talk about the pros and cons about all the treatment options available—exercise, therapy, and pills,” he said. “If a patient says, ‘I’m not really keen on medication and therapy, I want to use exercise,’ then if it’s appropriate, they can try it. But I give them caveats about how they should be monitoring it. I don’t say, ‘Go exercise and call me if it doesn’t work.’”
Here’s how he goes about this unconventional type of prescription:
“People will take the disease and treatment lightly if they know Paxil is coming.
First, Trivedi must gently raise the idea of exercise as a treatment option—patients often don’t know to ask. (There are no televised pharmaceutical ads for running, he notes.) He then tells patients about the studies, the amount of exercise that would be required, and the heart rate they’d need to reach. Based on a recent study by Trivedi and others, he recommends three to five sessions per week. Each one should last 45 to 60 minutes, and patients should reach 50 to 85 percent of their maximum heart rates.
He and the patient then blueprint a weekly workout schedule together. Not doing enough sessions, he warns, would be like a diabetic person “using insulin only occasionally.” He encourages patients to use FitBits or other monitoring gadgets to track their progress—and to guilt them off the couch.
Trivedi says this approach rests on three key elements. “One, you have to be very clear with patients that just because exercise has been shown to be efficacious, it doesn’t work for everyone. Two, the dose of the treatment is very important; you can’t just go for a stroll in the park. And three, there has to be a constant vigilance about the monitoring of symptoms. If the treatment is not working, you need to do something.”
That “something” could be adding antidepressants back into the mix—but only if the workouts have truly failed.
“People will take the disease and treatment lightly,” he said, “if they know Paxil is coming.”

The insurance challenge
When it comes to non-drug remedies for depression, exercise is actually just one of several promising options. Over the past few months, research has shown that other common lifestyle adjustments, like meditating or getting more sleep, might also relieve symptoms. Therapy has been shown to work just as well as SSRIs and other medications. In fact, a major JAMA study a few years ago cast doubt on the effectiveness of antidepressants in general, finding that the drugs don’t function any better than placebo pills for people with mild or moderate depression.
The half-dozen psychiatrists I interviewed said they’ve started to incorporate non-drug treatments into their plans for depressed patients. But they said they’re only able to do that because they don’t accept insurance. (One of the doctors works for a college system and only sees students.)
That’s because insurers still largely reimburse psychiatrists, like all other doctors, for each appointment—whatever that appointment may entail—rather than for curing a given patient. It takes less time to write a prescription for Zoloft than it does to tease out a patient’s options for sleeping better and breaking a sweat. Fewer moments spent mapping out jogging routes or sleep schedules means being able to squeeze in more patients for medications each day.
“[Psychiatrists] can probably do four medication-management visits in an hour,” said Chuck Ingoglia, a senior vice president at the National Council for Behavioral Health. “If they were doing therapy, they might see one person for 50 minutes.”
An insurance company might pay an internist and a psychiatrist both $100 for an appointment, but a primary care check-up might take 15 minutes while a thorough conversation with a psychiatrist takes 40 or more.
Because of these constraints, psychiatrists are among the least likely specialists to accept insurance—only about 55 percent of them do. Henry David Abraham, a psychiatrist in Lexington, Massachusetts, said he stopped accepting insurance once he realized his patient visits were becoming too rushed.
“I was seeing patients for 15 minutes each to give them drugs,” he said. “What would my mentors say about that quality of care? They would say, ‘Horrible!’”
He now sees patients on a sliding scale, with the wealthy essentially footing the bill for the poor. His sessions include a range of treatment options, including therapy.
“One patient lost a husband to cancer, and medication may take the edge off of some of those emotions, but the process she requires is to work through the elements of grief,” he said. “There’s not a pill for that.”
Meanwhile, psychiatrists who take insurance are increasingly less likely to offer talk therapy—or longer appointments of any kind—because licensed social workers and psychologists can offer the same types of sessions at lower rates.
“If you’re an insurance company, and you can get a social worker to do therapy for $50, that becomes the floor,” Ingoglia said.When Brittany, a woman who lives in northern Virginia, first began experiencing panic attacks a few months ago, she turned to a series of providers in her insurance network. None of the doctors she saw wanted to discuss anything but drug options, she said.
“They were all just throwing medication at me,” she said. (She asked that I not use her last name). “I said I don’t want medicine, but they didn’t want to talk about a long-term therapeutic plan.”
She went through eight different providers before finally finding a psychiatrist who helped her establish a plan to do yoga several times a week to manage her panic disorder. Those psychiatrist appointments are 90 minutes long.
Exacerbating all of this is the fact that there’s a shortage of psychiatrists, and the needs of people with mental health issues are increasingly being addressed by primary-care doctors, who now provide over a third of all mental health-care in the U.S. Sixty-two percent of all antidepressant prescriptions are now written by general practitioners, ob-gyns, and pediatricians.
But general practitioners aren’t always as equipped as psychiatrists to diagnose and treat depression. In 2007, 73 percent of patients who were prescribed an antidepressant were not given psychiatric diagnoses. In other cases, primary care doctors may balk at the idea of prescribing any interventions because they don’t feel they know enough about depression.
Writing in The New Yorker last year, primary care internist Suzanne Koven said she’s often at a loss when faced with “the lawyer who’s having trouble meeting deadlines and wants medication for attention-deficit disorder. Or the businesswoman whose therapist told her to see me about starting an antidepressant.”
She feared she lacked “the time or training to diagnose and manage many psychiatric disorders,” she wrote.

Managing life’s roadblocks
Let’s say you’re a psychiatrist who has managed to start incorporating sleep, exercise, and other non-drug remedies into a patient’s depression treatment. Congratulations! You now face a patient who is, very possibly, lethargic, unsatisfied, and lying about how many times he or she went running last week.
That is, if you can convince the patient to try anything other than drugs in the first place.
Julia Samton, a psychiatrist who practices in New York City, said she prescribes medications as a “third-tier resort” after lifestyle changes and therapy have been ruled out. She spends 45 minutes on each appointment, attempting to punch through her patients’ stony Manhattanite exteriors and expose the foundations of their agony.
“There are some people who say all they want is medication,” she said. “But they are the ones who are suffering tremendously and have a difficult time accessing their mental life. They want things fixed, and fixed right now.”
She said some of her patients are lured by the drug ads they see on TV— charming little spots that make it look like a gloomy day is nothing an SSRI can’t handle.
“It’s evocative to see a commercial where your world could change from black and white to color,” she said.
Beth Salcedo is a psychiatrist near Washington, D.C. People in this perpetual type-A convention of a town tend to have too much work, too-lofty aspirations, too high a rent, and too little time left before their evening networking event starts.
“I think it’s difficult to convince people to spend half an hour a day on exercise when they have kids, a job, and it can take months to see the benefit,” she said.
Some patients claim they can’t make time for the gym, or are adamant that they can’t afford to sleep more than six hours each night. And lawyers who work 16-hour days are not going to sit through long counseling appointments no matter how many peer-reviewed studies you wave at them.
“What do you do? Do you let them walk around depressed?” Salcedo said. “Or do you offer them a treatment that they’ll accept? Everyone has to do the thing that works for them.”
And despite its merits, exercise is not nearly as portable or painless as a tablet.
Salcedo had one patient whose mood entirely depended on her workouts. The hitch was that her exercise of choice was swimming—and the only pool she had access to was outdoors. “In the spring, fall, and winter, it wasn’t so easy,” Salcedo said.
Depressed patients are also more likely than most to feel unmotivated, so even the best-laid exercise treatment plan can be thwarted by a few days of staying in bed for an extra hour.
“Depressed patients have apathy or a lack of energy. Or they have anxiety disorders so they’re not going to go to the gym. Or they’re afraid to be seen jogging across Monument Avenue,” said Joan Plotkin Han, a staff psychiatrist at Virginia Commonwealth University in Richmond. Still, she pushes it with her more intrepid patients. “I don’t want to be that intimidating or threatening, but I’m a nag. And I will nag them.”
Of course, sometimes exercise works as a multiplier, augmenting the effectiveness of an existing treatment, including drugs or therapy, or simply by helping the patient regain agency in their lives. Many patients recover from depression faster when the disease is attacked through multiple approaches simultaneously.
Ginsberg said exercise didn’t cure him, but it did give him the energy to sort through the origins of his inner turmoil. And Brittany did eventually go on SSRIs to halt her nightly panic attacks—but now that yoga has her anxiety under control, she’s tapering off the drugs once again.
Exercise, like any other treatment, won’t work for every depressed patient. But the psychiatrists who incorporate it into their practices are finding that the only way it can work is if it’s treated like real medicine.
“The issue is that exercise seems as straightforward and simple as apple pie and your mom,” Trivedi said. “Everybody knows what it is, so it’s misunderstood. It’s important to explain to patients the seriousness of the disease they have and the nuances of the intervention they need.”





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Residual depression has lasting impact on bipolar patientsBy Eleanor McDermid, Senior medwireNews ReporterIn bipolar disorder, depressive symptoms are not only negatively associated with the outcome, but also affect verbal memory performanceA prospective study confirms the detrimental effect of subthreshold depressive symptoms on the outcomes of patients with bipolar disorder.
The findings, published in the Journal of Affective Disorders, also suggest that the effect is partly mediated by cognitive impairment.Researcher Anabel Martínez-Arán (University of Barcelona, Spain) and colleagues say that most studies have been cross-sectional, whereas they followed up 111 patients for 1 year. The patients were aged an average of 40 years and 78.4% had bipolar I disorder; all were euthymic at inclusion.
The team assessed verbal memory (using the California Verbal Learning Test), because impairment in this neurocognitive function is thought to be a core feature of bipolar disorder. Along with subsyndromal depressive symptoms (≤8 on the Hamilton Depression Rating Scale), patients’ composite verbal memory score explained 19% of the variance in their baseline scores on the Functioning Assessment Short Test (FAST).
Subthreshold depressive symptoms and verbal memory were associated with each other, such that patients with more depressive symptoms had larger memory impairments. They were also individually associated with baseline functional status.
“Thus in bipolar disorder, depressive symptoms are not only negatively associated with the outcome, but also affect verbal memory performance,” say the researchers.
Verbal memory had a significant indirect effect on outcome, partly mediating the relationship between depressive symptoms and functional status.
During 1 year of follow-up, patients’ functional status remained fairly stable overall, with average FAST scores of 29 at baseline and 27 at follow-up. Baseline functional status explained 44% of the variance in 1-year functional outcomes.
As baseline functional status was, in turn, partly dependent on depressive symptoms and verbal memory, these variables therefore contribute to follow-up functional outcomes, explain Martínez-Arán et al.The researchers note, however, that the study only assessed verbal memory, and impairments in this domain could be partly caused by other neurocognitive deficits.
“The identification of mediators in the prediction of functional outcome may help to disentangle the complex network of variables that contribute to functional outcome, since many variables with direct and indirect effects might be involved,” they conclude.


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Residual depression has lasting impact on bipolar patients
By Eleanor McDermid, Senior medwireNews Reporter

In bipolar disorder, depressive symptoms are not only negatively associated with the outcome, but also affect verbal memory performance

A prospective study confirms the detrimental effect of subthreshold depressive symptoms on the outcomes of patients with bipolar disorder.

The findings, published in the Journal of Affective Disorders, also suggest that the effect is partly mediated by cognitive impairment.
Researcher Anabel Martínez-Arán (University of Barcelona, Spain) and colleagues say that most studies have been cross-sectional, whereas they followed up 111 patients for 1 year. The patients were aged an average of 40 years and 78.4% had bipolar I disorder; all were euthymic at inclusion.

The team assessed verbal memory (using the California Verbal Learning Test), because impairment in this neurocognitive function is thought to be a core feature of bipolar disorder. Along with subsyndromal depressive symptoms (≤8 on the Hamilton Depression Rating Scale), patients’ composite verbal memory score explained 19% of the variance in their baseline scores on the Functioning Assessment Short Test (FAST).

Subthreshold depressive symptoms and verbal memory were associated with each other, such that patients with more depressive symptoms had larger memory impairments. They were also individually associated with baseline functional status.

“Thus in bipolar disorder, depressive symptoms are not only negatively associated with the outcome, but also affect verbal memory performance,” say the researchers.

Verbal memory had a significant indirect effect on outcome, partly mediating the relationship between depressive symptoms and functional status.

During 1 year of follow-up, patients’ functional status remained fairly stable overall, with average FAST scores of 29 at baseline and 27 at follow-up. Baseline functional status explained 44% of the variance in 1-year functional outcomes.

As baseline functional status was, in turn, partly dependent on depressive symptoms and verbal memory, these variables therefore contribute to follow-up functional outcomes, explain Martínez-Arán et al.
The researchers note, however, that the study only assessed verbal memory, and impairments in this domain could be partly caused by other neurocognitive deficits.

“The identification of mediators in the prediction of functional outcome may help to disentangle the complex network of variables that contribute to functional outcome, since many variables with direct and indirect effects might be involved,” they conclude.





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Depression, anxiety: What worked for meBy Gayathri Ramprasad; founder and president of ASHA International, a nonprofit organization promoting personal, organizational and community wellness. She is the author of “Shadows in the Sun: Healing from Depression and Finding the Light Within.Depression is no longer a demon I fear, it is a teacher whose wisdom I seek.For more than a decade of my life, I struggled with debilitating anxiety, panic attacks and depression. And, like millions of people around the world, I longed to discover a magic pill to cure my ills and promise me nirvana.But, despite taking many medications, ongoing psychotherapy, electroconvulsive therapy (ECTs), hospitalizations and failed suicide attempts, wellness remained a distant dream.The anti-anxiety medications and antidepressants worsened my symptoms, and made me more agitated, depressed and suicidal. And I was utterly confused why the medications that were supposed to alleviate my symptoms exacerbated them instead.Staring out of the fifth-floor hospital window one day after yet another failed suicide attempt, I promised to take charge of my life and create a life of wellness. I was sick and tired of being a chronically mentally ill patient. I just wanted to be well.Most of all, I wanted to be able to take my little girl to school, play with her in the park, and tuck her to bed at night with her favorite story.Somewhere deep in my soul, I was convinced that the medications were making me sicker instead of helping me heal. So, despite my fears and those of my family, I decided to listen to my inner wisdom and wean myself off all medications under the supervision of my psychiatrist and explore holistic pathways to health and wellness.Transcendental meditationWhen a medical resident at the hospital suggested I try transcendental meditation to manage my anxiety and depression, I did.Ironically, it was an American teacher, Pat, who taught me this life-affirming practice that had originated in India, my country of birth. I still remember sitting cross-legged on a Persian carpet across from Pat, in the dining-room-turned-shrine in her home.While Pat sat still, Buddha-like, eyes closed, breath steady, body relaxed, face serene, my breath was erratic, my eyelids fluttered like the wings of a hummingbird, and my “monkey mind” ran amok.But, one day, one breath at a time, I learned how to sit still. Despite my mind’s tendency to wander, like a mother lovingly guiding her wayward child back to its task I learned to gently guide my mind back to its still center. There, I discovered an oasis of energy, creativity, and restful calm.In time, meditation offered me a sacred space to reflect on my life, and taught me to become an observer of my thoughts and emotions instead of getting entangled in them. Eventually, the daily practice of meditation helped me regulate my emotions and live each moment with mindfulness. Ultimately, meditation set me free from the limitations of my suffering, and awakened me to a life filled with eternal possibilities.ExerciseDuring a visit, my psychiatrist recommended I start exercising, and educated me about the benefits of exercise in managing my anxiety and depression and promoting overall well-being.I joined a health club and started working out three times a week, attended aerobics and yoga classes and trained with free weights.I fell in love with my yoga classes. They relaxed and rejuvenated my mind, body, and spirit. Having never been athletic, I was surprised to find that exercise energized me and elevated my mood. It also provided a much-needed reprieve from my duties as a mother and homemaker, and helped me create a social network outside of my family.Cognitive behavioral therapyAlthough I was highly skeptical about how talking with a therapist could help me heal, it transformed my life.For the first time in my life, Dr. Lin, my therapist, explained how our thoughts, feelings, moods and behavior were interwoven, and taught me how to identify negative, self-defeating thoughts and replace them with positive, life-affirming thoughts.She also taught me how to regulate my breathing to manage my anxiety, and self-talk to break through the vicious cycle of depressive ruminations and suicidal ideation. She recommended I read “Feeling Good” by Dr. David Burns, which further reinforced the skills she taught, and served as a workbook for my life.Difficult at first, with practice the cognitive behavioral skills gradually became autonomous as breathing. Albert Einstein once said, “The world we have created is a product of our thinking; it cannot be changed without changing our thinking.” The tools of cognitive behavioral therapy, in essence, helped change my thinking, and, therefore, my world.Over the past 24 years, I have learned that wellness does not come encapsulated in a pill; rather, it encompasses the way I live. The consistent practice of transcendental meditation, exercise, and cognitive behavioral therapy have helped me thrive in life despite recurrent bouts of anxiety and depression.Depression is no longer a demon I fear, it is a teacher whose wisdom I seek.

For more mental health news, Click Here to access the Serious Mental Illness Blog

Depression, anxiety: What worked for me
By Gayathri Ramprasad; founder and president of ASHA International, a nonprofit organization promoting personal, organizational and community wellness. She is the author of “Shadows in the Sun: Healing from Depression and Finding the Light Within.

Depression is no longer a demon I fear, it is a teacher whose wisdom I seek.

For more than a decade of my life, I struggled with debilitating anxiety, panic attacks and depression. And, like millions of people around the world, I longed to discover a magic pill to cure my ills and promise me nirvana.
But, despite taking many medications, ongoing psychotherapy, electroconvulsive therapy (ECTs), hospitalizations and failed suicide attempts, wellness remained a distant dream.
The anti-anxiety medications and antidepressants worsened my symptoms, and made me more agitated, depressed and suicidal. And I was utterly confused why the medications that were supposed to alleviate my symptoms exacerbated them instead.
Staring out of the fifth-floor hospital window one day after yet another failed suicide attempt, I promised to take charge of my life and create a life of wellness. I was sick and tired of being a chronically mentally ill patient. I just wanted to be well.
Most of all, I wanted to be able to take my little girl to school, play with her in the park, and tuck her to bed at night with her favorite story.
Somewhere deep in my soul, I was convinced that the medications were making me sicker instead of helping me heal. So, despite my fears and those of my family, I decided to listen to my inner wisdom and wean myself off all medications under the supervision of my psychiatrist and explore holistic pathways to health and wellness.

Transcendental meditation
When a medical resident at the hospital suggested I try transcendental meditation to manage my anxiety and depression, I did.
Ironically, it was an American teacher, Pat, who taught me this life-affirming practice that had originated in India, my country of birth. I still remember sitting cross-legged on a Persian carpet across from Pat, in the dining-room-turned-shrine in her home.
While Pat sat still, Buddha-like, eyes closed, breath steady, body relaxed, face serene, my breath was erratic, my eyelids fluttered like the wings of a hummingbird, and my “monkey mind” ran amok.
But, one day, one breath at a time, I learned how to sit still. Despite my mind’s tendency to wander, like a mother lovingly guiding her wayward child back to its task I learned to gently guide my mind back to its still center. There, I discovered an oasis of energy, creativity, and restful calm.
In time, meditation offered me a sacred space to reflect on my life, and taught me to become an observer of my thoughts and emotions instead of getting entangled in them. Eventually, the daily practice of meditation helped me regulate my emotions and live each moment with mindfulness. Ultimately, meditation set me free from the limitations of my suffering, and awakened me to a life filled with eternal possibilities.

Exercise
During a visit, my psychiatrist recommended I start exercising, and educated me about the benefits of exercise in managing my anxiety and depression and promoting overall well-being.
I joined a health club and started working out three times a week, attended aerobics and yoga classes and trained with free weights.
I fell in love with my yoga classes. They relaxed and rejuvenated my mind, body, and spirit. Having never been athletic, I was surprised to find that exercise energized me and elevated my mood. It also provided a much-needed reprieve from my duties as a mother and homemaker, and helped me create a social network outside of my family.

Cognitive behavioral therapy
Although I was highly skeptical about how talking with a therapist could help me heal, it transformed my life.
For the first time in my life, Dr. Lin, my therapist, explained how our thoughts, feelings, moods and behavior were interwoven, and taught me how to identify negative, self-defeating thoughts and replace them with positive, life-affirming thoughts.
She also taught me how to regulate my breathing to manage my anxiety, and self-talk to break through the vicious cycle of depressive ruminations and suicidal ideation. She recommended I read “Feeling Good” by Dr. David Burns, which further reinforced the skills she taught, and served as a workbook for my life.
Difficult at first, with practice the cognitive behavioral skills gradually became autonomous as breathing. Albert Einstein once said, “The world we have created is a product of our thinking; it cannot be changed without changing our thinking.” The tools of cognitive behavioral therapy, in essence, helped change my thinking, and, therefore, my world.
Over the past 24 years, I have learned that wellness does not come encapsulated in a pill; rather, it encompasses the way I live. The consistent practice of transcendental meditation, exercise, and cognitive behavioral therapy have helped me thrive in life despite recurrent bouts of anxiety and depression.
Depression is no longer a demon I fear, it is a teacher whose wisdom I seek.




For more mental health news, Click Here to access the Serious Mental Illness Blog

(Source: CNN)

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Nearly 1 in 5 had mental illness before enlisting in Army, study saysBy Alan Zarembo (alan.zarembo@latimes.com)
The study raises questions about the military’s screening of recruits. Another study looks at rising suicide rates among soldiers.
Nearly 1 in 5 U.S. soldiers had a common mental illness, such as depression, panic disorder or ADHD, before enlisting in the Army, according to a new study that raises questions about the military’s assessment and screening of recruits.
More than 8% of soldiers had thought about killing themselves and 1.1% had a past suicide attempt, researchers found from confidential surveys and interviews with 5,428 soldiers at Army installations across the country.
The findings, published online Monday in two papers in JAMA Psychiatry, point to a weakness in the recruiting process, experts said. Applicants are asked about their psychiatric histories, and those with certain disorders or past suicide attempts are generally barred from service.
"The question becomes, ‘How did these guys get in the Army?’" said Ronald Kessler, a Harvard University sociologist who led one of the studies.
A third study looked at the increased suicide rate among soldiers from 2004 to 2009. The study, which tracked nearly 1 million soldiers, found that those who had been deployed to Afghanistan or Iraq had an increased rate of suicide.
But it also found that the suicide rate among soldiers who had never deployed also rose steadily during that time. The study did not explain the cause.
The Pentagon did not make officials available Monday to discuss the studies.
The three studies are the first from a massive research initiative started in 2009 by the Army and the National Institutes of Mental Health in response to the surge in suicides.
In 2011, a representative sample of soldiers was extensively questioned and assessed for a history of eight common psychiatric disorders.
Traditionally, the Army has been psychologically healthier than the rest of society because of screening, fitness standards and access to healthcare. Soldiers committed suicide at about half the rate of civilians with similar demographics.
But researchers found that soldiers they interviewed had joined the Army with significantly higher rates of post-traumatic stress disorder, panic disorder and attention deficit and hyperactivity disorder than those in the general population.
Most notably, more than 8% of soldiers entered the Army with intermittent explosive disorder, characterized by uncontrolled attacks of anger. It was the most common disorder in the study, with a pre-enlistment prevalence nearly six times the civilian rate.
"The kind of people who join the Army are not typical people," Kessler said. "They have a lot more acting-out kind of mental disorders. They get into fights more. They’re more aggressive."
The researchers found that despite screening, pre-enlistment rates of depression, anxiety, bipolar disorder and substance abuse were on par with civilian rates. Rates of suicidal ideation, planning and attempts were lower than in the general population but still significant, given the military’s practice of excluding recruits with a known suicidal history.
During their military service, the soldiers’ rates of most psychiatric disorders climbed well past civilian levels, several times the rate for some disorders.
A quarter of soldiers were deemed to be suffering from a mental illness — almost 5% with depression, nearly 6% with anxiety disorder and nearly 9% with PTSD. The percentage of soldiers who had attempted suicide rose from 1.1% to 2.4%.
Matthew Nock, a Harvard University psychologist who led the study on suicide, said more than 30% of suicide attempts that occurred after enlistment would have been prevented if the Army had excluded recruits with pre-existing mental health conditions.
Nock said he believed the Army should improve its screening of recruits, not to exclude them but to provide treatment to those who acknowledge a history of mental illness.
Screening out mentally ill recruits is not as simple as it sounds because the military largely has to rely on applicants to disclose their mental health histories.
"People who want to come into the Army are no fools," said Dr. Elspeth Ritchie, a former chief psychiatrist in the Army. "They know if you say you had a past suicide attempt, you’re probably not going to get in."
Dr. Eric Schoomaker, who served as surgeon general of the Army until 2012, said more stringent screening “would just lead to driving the problems further underground.”
In addition, the military would not meet its recruiting targets if it were able to identify and exclude everybody with a history of mental health problems, experts said.
During the peak years of war, as the military was struggling to fill its ranks, some recruiters were known to discourage applicants from disclosing such problems.


For more mental health news, Click Here to access the Serious Mental Illness Blog

Nearly 1 in 5 had mental illness before enlisting in Army, study says
By Alan Zarembo (alan.zarembo@latimes.com)

The study raises questions about the military’s screening of recruits. Another study looks at rising suicide rates among soldiers.

Nearly 1 in 5 U.S. soldiers had a common mental illness, such as depression, panic disorder or ADHD, before enlisting in the Army, according to a new study that raises questions about the military’s assessment and screening of recruits.

More than 8% of soldiers had thought about killing themselves and 1.1% had a past suicide attempt, researchers found from confidential surveys and interviews with 5,428 soldiers at Army installations across the country.

The findings, published online Monday in two papers in JAMA Psychiatry, point to a weakness in the recruiting process, experts said. Applicants are asked about their psychiatric histories, and those with certain disorders or past suicide attempts are generally barred from service.

"The question becomes, ‘How did these guys get in the Army?’" said Ronald Kessler, a Harvard University sociologist who led one of the studies.

A third study looked at the increased suicide rate among soldiers from 2004 to 2009. The study, which tracked nearly 1 million soldiers, found that those who had been deployed to Afghanistan or Iraq had an increased rate of suicide.

But it also found that the suicide rate among soldiers who had never deployed also rose steadily during that time. The study did not explain the cause.

The Pentagon did not make officials available Monday to discuss the studies.

The three studies are the first from a massive research initiative started in 2009 by the Army and the National Institutes of Mental Health in response to the surge in suicides.

In 2011, a representative sample of soldiers was extensively questioned and assessed for a history of eight common psychiatric disorders.

Traditionally, the Army has been psychologically healthier than the rest of society because of screening, fitness standards and access to healthcare. Soldiers committed suicide at about half the rate of civilians with similar demographics.

But researchers found that soldiers they interviewed had joined the Army with significantly higher rates of post-traumatic stress disorder, panic disorder and attention deficit and hyperactivity disorder than those in the general population.

Most notably, more than 8% of soldiers entered the Army with intermittent explosive disorder, characterized by uncontrolled attacks of anger. It was the most common disorder in the study, with a pre-enlistment prevalence nearly six times the civilian rate.

"The kind of people who join the Army are not typical people," Kessler said. "They have a lot more acting-out kind of mental disorders. They get into fights more. They’re more aggressive."

The researchers found that despite screening, pre-enlistment rates of depression, anxiety, bipolar disorder and substance abuse were on par with civilian rates. Rates of suicidal ideation, planning and attempts were lower than in the general population but still significant, given the military’s practice of excluding recruits with a known suicidal history.

During their military service, the soldiers’ rates of most psychiatric disorders climbed well past civilian levels, several times the rate for some disorders.

A quarter of soldiers were deemed to be suffering from a mental illness — almost 5% with depression, nearly 6% with anxiety disorder and nearly 9% with PTSD. The percentage of soldiers who had attempted suicide rose from 1.1% to 2.4%.

Matthew Nock, a Harvard University psychologist who led the study on suicide, said more than 30% of suicide attempts that occurred after enlistment would have been prevented if the Army had excluded recruits with pre-existing mental health conditions.

Nock said he believed the Army should improve its screening of recruits, not to exclude them but to provide treatment to those who acknowledge a history of mental illness.

Screening out mentally ill recruits is not as simple as it sounds because the military largely has to rely on applicants to disclose their mental health histories.

"People who want to come into the Army are no fools," said Dr. Elspeth Ritchie, a former chief psychiatrist in the Army. "They know if you say you had a past suicide attempt, you’re probably not going to get in."

Dr. Eric Schoomaker, who served as surgeon general of the Army until 2012, said more stringent screening “would just lead to driving the problems further underground.”

In addition, the military would not meet its recruiting targets if it were able to identify and exclude everybody with a history of mental health problems, experts said.

During the peak years of war, as the military was struggling to fill its ranks, some recruiters were known to discourage applicants from disclosing such problems.



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Confessing DepressionBy Megan Davies Mennes; English teacher, writer, motherSometimes life is hard. I think I’m luckier than most in this world, and yet I still struggle with my own demons. I suppose that’s true of all of us, but not everyone faces the crushing weight of depression when things go wrong. I recently discovered that my dear friend is struggling to stay afloat and I want so desperately for him to know — for everyone experiencing the pain of depression to know — I’ve been there.Depression isn’t something we like to talk about in our society. Mental health in general is a rather taboo topic, perhaps because for those with no history of mental illness, it seems as simple as a change in mindset. But depression is very real, and often very difficult to control.I’ve struggled with depression, anxiety, and mood swings my whole life. I learned in early adulthood that I suffer from some pretty serious chemical imbalances that peak in the winter and ebb in the warmer months. I also know that stress can put me in a funk regardless of the weather. The past few years have been hard on me given the many changes we’ve experienced in our family. In fact, I suffered from late-onset post-partum depression when my first son, Atticus, was around 6 months old. The medicine my doctor prescribed made my skin crawl, so I lived with the sadness until things leveled out. And then when we moved to a new city, turned our entire lives upside-down, and received our unborn son Quinn’s Down syndrome diagnosis, the depression returned, this time with a severity I had never experienced. But the only drugs that we knew to fight the funk without the desire to pull my hair out or walk around like a zombie all day weren’t recommended for pregnant women (especially those with a high-risk pregnancy like mine), so I was forced to power through.It’s difficult to cope with something that many people feel is easy to fix. Over the years, I’ve had friends insist that I need learn to count my blessings, as if I hadn’t tried that before. Or they expect to snap me out of it with a quick hug, a phone call, or even chocolate cake. But depression doesn’t work that way. Depression is an all-encompassing reality that no amount of silver linings can overturn. Moreover, sometimes it feels normal to be sad. I know that’s not something that most of you can understand, but for those with chemical imbalances, they know how right it can feel to give in and allow the wave of hopelessness to take over. To fight it is to sink lower when you lose.The bright side is that there is a bright side. I’ve learned over the years to ride the waves of depression that come my way and seek help when they get too serious. I’m lucky in that my family keeps me close and ensures that recovery is swift. My husband is my rock in this. He knows what works and what doesn’t. And he never tries to fix me. He just listens. I’m also lucky that my depression has never affected my work, as walking into my classroom is like a refuge, as if I’ve suddenly found a life raft after treading water for days. But others aren’t so lucky. Others struggle to recover, regardless of their support system. If that’s you, then please seek help. It’s amazing how quickly depression can lead someone down a dead-end path. And once you start that road toward drug abuse, alcoholism, or even suicide, it’s hard to come back.Many of you will read this confession and feel embarrassed for me, or even sad. Don’t. I’m not ashamed. In fact, I’m actually pretty damn proud of my ability to overcome it and live a successful life. I’m proud of my coping mechanisms, my bursts of happiness in which I can appreciate the sun on my shoulders in late February, or the sound of my children’s giggles on Sunday mornings. Those are the moments I live for. Those are the moments that keep the depression at bay for longer stretches of time. In order for more people to find their moments, we need to talk about mental illness without shame or fear. We need to help more people become aware of the struggles so that we can be more aware of ways to help each other cope.
If you’re struggling with depression, anxiety, or any other mental illness, seek a strong support system. Here are some good places to start:
Depression and Bipolar Support Alliance.Helpguide.org.Mental Health America




For more mental health news, Click Here to access the Serious Mental Illness Blog

Confessing Depression
By Megan Davies Mennes; English teacher, writer, mother

Sometimes life is hard. I think I’m luckier than most in this world, and yet I still struggle with my own demons. I suppose that’s true of all of us, but not everyone faces the crushing weight of depression when things go wrong. I recently discovered that my dear friend is struggling to stay afloat and I want so desperately for him to know — for everyone experiencing the pain of depression to know — I’ve been there.
Depression isn’t something we like to talk about in our society. Mental health in general is a rather taboo topic, perhaps because for those with no history of mental illness, it seems as simple as a change in mindset. But depression is very real, and often very difficult to control.
I’ve struggled with depression, anxiety, and mood swings my whole life. I learned in early adulthood that I suffer from some pretty serious chemical imbalances that peak in the winter and ebb in the warmer months. I also know that stress can put me in a funk regardless of the weather. The past few years have been hard on me given the many changes we’ve experienced in our family. In fact, I suffered from late-onset post-partum depression when my first son, Atticus, was around 6 months old. The medicine my doctor prescribed made my skin crawl, so I lived with the sadness until things leveled out. And then when we moved to a new city, turned our entire lives upside-down, and received our unborn son Quinn’s Down syndrome diagnosis, the depression returned, this time with a severity I had never experienced. But the only drugs that we knew to fight the funk without the desire to pull my hair out or walk around like a zombie all day weren’t recommended for pregnant women (especially those with a high-risk pregnancy like mine), so I was forced to power through.
It’s difficult to cope with something that many people feel is easy to fix. Over the years, I’ve had friends insist that I need learn to count my blessings, as if I hadn’t tried that before. Or they expect to snap me out of it with a quick hug, a phone call, or even chocolate cake. But depression doesn’t work that way. Depression is an all-encompassing reality that no amount of silver linings can overturn. Moreover, sometimes it feels normal to be sad. I know that’s not something that most of you can understand, but for those with chemical imbalances, they know how right it can feel to give in and allow the wave of hopelessness to take over. To fight it is to sink lower when you lose.
The bright side is that there is a bright side. I’ve learned over the years to ride the waves of depression that come my way and seek help when they get too serious. I’m lucky in that my family keeps me close and ensures that recovery is swift. My husband is my rock in this. He knows what works and what doesn’t. And he never tries to fix me. He just listens. I’m also lucky that my depression has never affected my work, as walking into my classroom is like a refuge, as if I’ve suddenly found a life raft after treading water for days. But others aren’t so lucky. Others struggle to recover, regardless of their support system. If that’s you, then please seek help. It’s amazing how quickly depression can lead someone down a dead-end path. And once you start that road toward drug abuse, alcoholism, or even suicide, it’s hard to come back.
Many of you will read this confession and feel embarrassed for me, or even sad. Don’t. I’m not ashamed. In fact, I’m actually pretty damn proud of my ability to overcome it and live a successful life. I’m proud of my coping mechanisms, my bursts of happiness in which I can appreciate the sun on my shoulders in late February, or the sound of my children’s giggles on Sunday mornings. Those are the moments I live for. Those are the moments that keep the depression at bay for longer stretches of time. In order for more people to find their moments, we need to talk about mental illness without shame or fear. We need to help more people become aware of the struggles so that we can be more aware of ways to help each other cope.

If you’re struggling with depression, anxiety, or any other mental illness, seek a strong support system. Here are some good places to start:

Depression and Bipolar Support Alliance.
Helpguide.org.
Mental Health America



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Shameful Profiling of the Mentally IllBy Andrew Solomon, author of “Far From the Tree: Parents, Children, and the Search for Identity”A Canadian woman was denied entry to the United States last month because she had been hospitalized for depression in 2012. Ellen Richardson could not visit, she was told, unless she obtained “medical clearance” from one of three Toronto doctors approved by the Department of Homeland Security. Endorsement by her own psychiatrist, which she could presumably have obtained more efficiently, “would not suffice.” She had been en route to New York, where she had intended to board a cruise to the Caribbean.“I was so aghast,” Ms. Richardson told a Toronto Star reporter. “I don’t understand this. What is the problem?’ I was so looking forward to getting away. I’d even brought a little string of Christmas lights I was going to string up in the cabin.”The border agent told her he was acting in accordance with the United States Immigration and Nationality Act, Section 212, which allows patrols to block people from visiting the United States if they have a physical or mental disorder that threatens anyone’s “property, safety or welfare.” The Star reported that the agent produced a signed document stating that Ms. Richardson would need a medical evaluation because of her “mental illness episode.” A spokeswoman for United States Customs and Border Protection told the Star that the agency was prohibited from discussing specific cases because of privacy laws.This is not the first time such measures have been reported. In 2011, Lois Kamenitz, a Canadian and a former teacher, was barred from entering the United States because she had once attempted suicide. Ryan Fritsch, former co-chairman of the Ontario Mental Health Police Record Check Coalition, told the Star that he had heard of eight similar cases that year. After the incident, he wrote to me: “My sense is that there are a great many people being turned away. I’ve also heard of executive-level reps from various Canadian and provincial mental health advocacy and awareness organizations being turned away at the border on their way to conferences and other official functions and appearances,” presumably because of their own medical histories.Ms. Richardson’s health information should never have been available to United States authorities, and many Canadians are outraged at the thought that their government may have divulged it. It’s not clear at this point, however, what the customs agent saw.Her ruined vacation could have been a result of his access to law enforcement databases. Ms. Richardson explained to me that when she was hospitalized in June 2012, the police were involved because she had made a suicide attempt that led to a 911 call. But even if it is police data rather than medical data that has been shared, the use by immigration authorities remains troubling.Much more troubling, however, is the notion that information about a person’s depression, no matter how legitimately obtained, might have any bearing on her ability to visit the United States.People in treatment for mental illnesses do not have a higher rate of violence than people without mental illnesses. Furthermore, depression affects one in 10 American adults, according to estimates from the Centers for Disease Control and Prevention. Pillorying depression is regressive, a swoop back into a period when any sign of mental illness was the basis for social exclusion.The Americans With Disabilities Act of 1990 prevents employers from discriminating against people who have a mental illness. If we defend the right of people with depression to work anywhere, shouldn’t we defend their right to enter the country? Enshrining prejudice in any part of society enables it in others. Most of the people who fought for the right of gay people to serve in the military did so not because they hoped to become gay soldiers themselves, but because any program of government-sanctioned prejudice undermined the dignity of all gay people. Similarly, this border policy is not only unfair to visitors, but also constitutes an affront to the millions of Americans who are grappling with mental-health challenges.Stigmatizing the condition is bad; stigmatizing the treatment is even worse. People who have received help are much more likely to be in control of their demons than those who have not. Yet this incident will serve only to warn people against seeking treatment for mental illness. If we scare others off therapy lest it later be held against them, we are encouraging denial, medical noncompliance and subterfuge, thereby building not a healthier society but a sicker one.We have already seen such a situation: For more than 20 years the United States prohibited people with H.I.V. from entering the country. We were one of a very few countries to take this bigoted stand. An activist lobby fought against the ban, which was finally lifted in 2009. President Obama expressed his belief that the ban had led to bias against people with H.I.V., which discouraged people from getting tested.Ms. Richardson, who attempted suicide in 2001 and as a result is parapalegic, has asserted that she has had appropriate treatment, and that she now has a fulfilling, purposeful life. We should applaud people who get treatment and manage to live deeply despite their challenges. It is both humane and in our self-interest to ensure that as many people as possible avail themselves, without governmental disapprobation, of the array of supports that may help them. The president needs to speak out against Section 212 as he did against the H.I.V. ban and to put to rest the idea that people with mental health conditions who pose no danger are unwelcome in our country.



For more mental health news, Click Here to access the Serious Mental Illness Blog

Shameful Profiling of the Mentally Ill
By Andrew Solomon, author of “Far From the Tree: Parents, Children, and the Search for Identity”

A Canadian woman was denied entry to the United States last month because she had been hospitalized for depression in 2012. Ellen Richardson could not visit, she was told, unless she obtained “medical clearance” from one of three Toronto doctors approved by the Department of Homeland Security. Endorsement by her own psychiatrist, which she could presumably have obtained more efficiently, “would not suffice.” She had been en route to New York, where she had intended to board a cruise to the Caribbean.
“I was so aghast,” Ms. Richardson told a Toronto Star reporter. “I don’t understand this. What is the problem?’ I was so looking forward to getting away. I’d even brought a little string of Christmas lights I was going to string up in the cabin.”
The border agent told her he was acting in accordance with the United States Immigration and Nationality Act, Section 212, which allows patrols to block people from visiting the United States if they have a physical or mental disorder that threatens anyone’s “property, safety or welfare.” The Star reported that the agent produced a signed document stating that Ms. Richardson would need a medical evaluation because of her “mental illness episode.” A spokeswoman for United States Customs and Border Protection told the Star that the agency was prohibited from discussing specific cases because of privacy laws.
This is not the first time such measures have been reported. In 2011, Lois Kamenitz, a Canadian and a former teacher, was barred from entering the United States because she had once attempted suicide. Ryan Fritsch, former co-chairman of the Ontario Mental Health Police Record Check Coalition, told the Star that he had heard of eight similar cases that year. After the incident, he wrote to me: “My sense is that there are a great many people being turned away. I’ve also heard of executive-level reps from various Canadian and provincial mental health advocacy and awareness organizations being turned away at the border on their way to conferences and other official functions and appearances,” presumably because of their own medical histories.
Ms. Richardson’s health information should never have been available to United States authorities, and many Canadians are outraged at the thought that their government may have divulged it. It’s not clear at this point, however, what the customs agent saw.
Her ruined vacation could have been a result of his access to law enforcement databases. Ms. Richardson explained to me that when she was hospitalized in June 2012, the police were involved because she had made a suicide attempt that led to a 911 call. But even if it is police data rather than medical data that has been shared, the use by immigration authorities remains troubling.
Much more troubling, however, is the notion that information about a person’s depression, no matter how legitimately obtained, might have any bearing on her ability to visit the United States.
People in treatment for mental illnesses do not have a higher rate of violence than people without mental illnesses. Furthermore, depression affects one in 10 American adults, according to estimates from the Centers for Disease Control and Prevention. Pillorying depression is regressive, a swoop back into a period when any sign of mental illness was the basis for social exclusion.
The Americans With Disabilities Act of 1990 prevents employers from discriminating against people who have a mental illness. If we defend the right of people with depression to work anywhere, shouldn’t we defend their right to enter the country? Enshrining prejudice in any part of society enables it in others. Most of the people who fought for the right of gay people to serve in the military did so not because they hoped to become gay soldiers themselves, but because any program of government-sanctioned prejudice undermined the dignity of all gay people. Similarly, this border policy is not only unfair to visitors, but also constitutes an affront to the millions of Americans who are grappling with mental-health challenges.
Stigmatizing the condition is bad; stigmatizing the treatment is even worse. People who have received help are much more likely to be in control of their demons than those who have not. Yet this incident will serve only to warn people against seeking treatment for mental illness. If we scare others off therapy lest it later be held against them, we are encouraging denial, medical noncompliance and subterfuge, thereby building not a healthier society but a sicker one.
We have already seen such a situation: For more than 20 years the United States prohibited people with H.I.V. from entering the country. We were one of a very few countries to take this bigoted stand. An activist lobby fought against the ban, which was finally lifted in 2009. President Obama expressed his belief that the ban had led to bias against people with H.I.V., which discouraged people from getting tested.
Ms. Richardson, who attempted suicide in 2001 and as a result is parapalegic, has asserted that she has had appropriate treatment, and that she now has a fulfilling, purposeful life. We should applaud people who get treatment and manage to live deeply despite their challenges. It is both humane and in our self-interest to ensure that as many people as possible avail themselves, without governmental disapprobation, of the array of supports that may help them. The president needs to speak out against Section 212 as he did against the H.I.V. ban and to put to rest the idea that people with mental health conditions who pose no danger are unwelcome in our country.



For more mental health news, Click Here to access the Serious Mental Illness Blog

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[Film of Interest] Here One Day

In 1995, Nina Williams Leichter, the brilliant wife of a New York state senator, committed suicide by jumping from the 11th floor of her apartment building. Though she had struggled with manic depression, Williams had always been an energetic figure who tried to bring public attention to mental health issues. Her suicide shattered the lives of her family: her husband and two children, Josh and Kathy. Sixteen years later, Kathy Leichter, now a filmmaker, returns to stay in her parents’ apartment. Amid the collected letters, clothes and empty medication bottles, Leichter makes a discovery. In a plastic case, she finds dozens of audio cassettes made by her mother, emotional often rambling messages attempting to understand the madness overwhelming her. Over time, Leichter begins to chronicle, then come to terms with the full depth of her mother’s mental anguish. Here One Day is a powerful personal statement, threading together the disparate strands of Williams’ sorrow, ultimately becoming a moving evocation of life itself.

Here One Day attempts to educate and reduce stigma around mental illness and suicide, to link audiences to support, and to teach how mental illness and suicide impacts families. The film is available for DVD purchase and for community screenings facilitated by the film’s award-winning director, Kathy Leichter. For more information go to: http://www.hereoneday.com or contact her at info@hereoneday.com.



For more mental health news, Click Here to access the Serious Mental Illness Blog

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[In the News] Inside the National Suicide Hotline: Preventing the Next TragedyBy Josh Sanburn
As U.S. suicide rates rise, experts are divided over which strategies save more lives
Excerpt:
Kevin Hines paced along the Golden Gate Bridge, trying to figure out whether to obey the voices in his head urging him to jump. Anyone paying the slightest attention to Hines should’ve seen that something was horribly wrong. Sure enough, after about a half-hour, a woman approached him. Hines thought she was there to save his life.
Instead, she was a tourist wanting Hines to take her picture. The look of desperation on his face apparently didn’t register. Elation crumpled into despair. “Nobody cares,” he thought. “Absolutely nobody cares.”
Hines soon hurdled a railing, stepped out onto a ledge 25 stories above San Francisco Bay and jumped. He immediately regretted it. Falling 75 miles an hour headfirst toward the water, Hines realized that if he was going to save himself, he had to hit feet first. So he threw his head back right before he plunged 80 feet into the cold waters, shattering two of his lower vertebrae. He eventually surfaced and was rescued by the Coast Guard. Only one out of 50 who jump survive.
Thirteen years removed from his attempt, Hines is now an author and lecturer, and doing quite well considering his experience. Hines frequently travels around the country talking about what happened on September 25, 2000. Diagnosed with bipolar disorder, he still has auditory and visual hallucinations as well as paranoid delusions. But today, he has a support network of family and friends that check up on him and identify early warning signs that could lead to Hines harming himself again. He logs his symptoms into an online document he shares with others so they can keep an eye on him. Hines says that’s what separates him from so many others who have suicidal thoughts.
“When you learn to be self-aware with mental illness, you can save your own life,” Hines says.
In May, the Centers for Disease Control released data showing that in 2010, 38,364 people weren’t able to save themselves. For the first time, the number of suicides surpassed deaths from motor vehicle accidents and most researchers believe that number is low, if anything, because many suicides go unreported. The suicide rate for Americans aged 35 to 64 rose 28.4 percent from 1999 to 2010. According to the CDC, $35 billion is lost due to medical bills and work loss costs related to suicide each year. And while suicide rates are not as high as they were in the early 1990s, they’ve climbed steadily upward since 2005.
As more Americans commit suicide, some in the field question the effectiveness of current prevention programs. Over the last 15 years, public policy and federal funding have shifted toward a broader mental wellness movement aimed at helping people deal with anxiety and depression that could eventually lead to suicidality. But that shift may have left those most at-risk of suicide, like Hines, without the support they need.
One program sits at the intersection of those two approaches. The National Suicide Prevention Lifeline, which expects 1.1 million to 1.2 million calls this year and receives about 15 percent more callers each year, is broadly marketed to the general public through billboards and ads that reach those suffering from anxiety, depression and loneliness but are often not actively suicidal. At the same time, it’s an emergency resource for those who are at immediate risk of killing themselves and who struggle with chronic mental illness. But some in the field question its effectiveness, along with the effectiveness of many other services and programs funded and promoted on a national scale. Those in the field often use the metaphor of a river to illustrate the divide: Is it worth getting to more people upstream or narrowly targeting those like Hines downstream?
At the Waterfall
The bridge phone inside New York City’s suicide prevention call center only rings about once a month. But when it does, often in the middle of the night, it emits distinct, deep chirps – as if the phone itself is in distress. The operators manning the 24/7 LifeNet hotline recognize the ring immediately. It means someone’s calling from one of the area’s 11 bridges, and they’re likely thinking about jumping.
LifeNet, a suicide prevention hotline servicing New York’s metropolitan area, also serves as one of 161 call centers that make up the National Suicide Prevention Lifeline network, headquartered in the same building. During its busiest hours from 9 a.m. to 7 p.m., the hotline has roughly 20 operators working the phones inside their unassuming L-shaped office space in lower Manhattan. The operators could easily be mistaken for a collection of telemarketers. The large computer screen at the head of the call center showing the number of lines being processed could easily reside inside QVC’s customer service center.
You don’t get a sense of what truly happens in this room until you run across the bridge phone, which is a direct line to the call center. It’s LifeNet’s equivalent of the Oval Office’s mythical red phone. On the wall above it, black Ikea picture frames display detailed information for each bridge and the locations of its call boxes: “Northbound 3rd Avenue Exit,” “Westbound Light Pole 60.” If someone calls, they can use the caller ID, check the information above the phone and immediately locate the caller and send help.
If it were up to those who work at LifeNet, however, they would get rid of the bridge phone altogether. “What we want is to get people upstream,” says John Draper, director of the National Suicide Prevention Lifeline. “We don’t necessarily want to get people who are on the edge of the waterfall. If they are, we can help them. But it’s a huge cost savings for the entire mental health system if you can get people further upstream.”
Draper is the National Suicide Prevention Lifeline’s soft-spoken, goateed, pony-tailed director and a whole-hearted advocate for early treatment. Talk to him and you realize why he’s in this field, something, he says, chose him. Draper speaks calmly but with purpose. He looks you in the eye. He routinely uses your name in conversation.
In the 1980s, Draper was part of a mobile crisis team, a group of clinicians that goes into the homes of people who are psychiatrically ill but unable or unwilling to get help. He says he soon came to the realization that the country’s mental health system operated behind bricks and mortar, “where it waits for people.”
“It says, ‘Ok, you’re mentally ill?’ I’ll see you Tuesday at 9 a.m. Hope you can make it.’ The system is not set up for the convenience of the user,” he says. “And as a result, two-thirds of the people with mental health problems in this country never seek care. So here was this program that goes into people’s homes. I was like, man, this is the way it should be.”
A decade later, the Mental Health Association of New York City established a 24/7 crisis information and referral network and hired Draper. Several years later, the Substance Abuse and Mental Health Services Administration (SAMHSA), which is part of the U.S. Department of Health and Human Services and now partially funds the national lifeline, assessed callers who had contacted crisis centers like New York’s and found that most of them felt less distressed emotionally and were less suicidal after the call. Draper calls it a groundbreaking finding.
LifeNet came into its own in 2001 when it became a central resource for those affected by the Sept. 11 terrorist attacks, which in New York City was just about everybody. People were reporting depression, anxiety and other traumatic responses in massive numbers. LifeNet’s call volume and staff doubled, and it’s never gone down. That time in the spotlight positioned the hotline to administer the national suicide prevention lifeline starting in 2004.
Today, Draper and his staff oversee more than 160 networked call centers around the country. Call 1-800-273-TALK, and you’ll be routed to the call center closest to the phone number from which you’re calling. The staff, funded with $3.7 million a year by SAMHSA, helps develop risk assessment standards for operators around the country so they can consistently and quickly determine the seriousness of a situation over the phone.
Draper expects call volume to increase again this year. About 8 million adults in the U.S. are thinking seriously about suicide, but only 1.1 million actually attempt it. So when Draper sees the volume actually reaching that 1.1 million number, which he expects it to this year, he views it as a good thing.
“If your calls are increasing, does that mean more people are in distress?” he says. “That’s not necessarily true. It means more people may have been in distress all along but didn’t know this resource was there. So the more we promote awareness of this resource, once it gets out, then it stays out there.”
The problem for people like Draper is definitively determining whether suicide prevention efforts are working. The only way you ever know if you’re saving someone’s life is if they come out and say so, and that makes it difficult to truly gauge the effectiveness of the lifeline or any other prevention program or service.
“The lifeline is a valuable addition to our efforts,” says Dr. Lanny Berman, executive director of the American Association of Suicidology (AAS). “It’s indeed a resource for people in suicidal crisis to reach out immediately and get help. Whether it is effective in saving lives remains to be seen.”
But some of the available data seems to indicate that the lifeline is having a positive effect. Studies done by Columbia University’s Dr. Madelyn Gould have found that about 12 percent of suicidal callers reported in a follow-up interview that talking to someone at the lifeline prevented them from harming or killing themselves. Almost half followed through with a counselor’s referral to seek emergency services or contacted mental health services, and about 80 percent of suicidal callers say in follow-up interviews that the lifeline has had something to do with keeping them alive.
“I don’t know if we’ll ever have solid evidence for what saves lives other than people saying they saved my life,” says Draper. “It may be that the suicide rate could be higher if crisis lines weren’t in effect. I don’t know. All I can say is that what we’re hearing from callers is that this is having a real life-saving impact.”
[…]
You may think that a suicide prevention office would be a dreadful place to work, but it’s really just like any other around the country: idle chatter near the water cooler, lunch breaks with co-workers, cinnamon rolls in the break room. It’s just that from this room, lives are being profoundly affected every day. And even though the exact number of people who have truly been helped will never be known, the lifeline has very strong advocates, including Kevin Hines.
Hines’ story is not merely dramatic; it’s a test case in how the mental health system broke down. There are essentially three main ways to prevent suicide: treatment; means prevention; and access to prevention resources. At the time, Hines wasn’t properly being treated for bipolar disorder; the Golden Gate Bridge has no physical barriers to prevent suicide attempts; and as for the bridge’s suicide prevention call box, Hines didn’t know it was there.
“Had I known, I’m sure I would’ve called,” he says, “because I desperately wanted to talk to somebody.”
Back in New York City’s suicide prevention call center, I ask Draper if it’s difficult to come in to work each day, to motivate his employees to take another call and assure them that what they’re all doing is actually working.
“When I tell people what I do, they say, ‘Oh, Draper, that must be really depressing,’” he says. “And I say, man, I’m in the suicide prevention business, not the suicide business. What I see every day and what our crisis center staff hears every day is hope. And they know that they’re a part of that.”
He says it’s important to remember that 1.1 million adults are attempting suicide every year, but 38,000 are actually dying by suicide.
“What that is telling us is that by and large, the overwhelming majority of suicides are being prevented,” he says. “And those stories are not being told.”
Read the whole story at: http://healthland.time.com/2013/09/13/inside-the-national-suicide-hotline-counselors-work-to-prevent-the-next-casualty/#ixzz2es8LLygE


For more mental health news, Click Here to access the Serious Mental Illness Blog

[In the News] Inside the National Suicide Hotline: Preventing the Next Tragedy
By Josh Sanburn

As U.S. suicide rates rise, experts are divided over which strategies save more lives

Excerpt:

Kevin Hines paced along the Golden Gate Bridge, trying to figure out whether to obey the voices in his head urging him to jump. Anyone paying the slightest attention to Hines should’ve seen that something was horribly wrong. Sure enough, after about a half-hour, a woman approached him. Hines thought she was there to save his life.

Instead, she was a tourist wanting Hines to take her picture. The look of desperation on his face apparently didn’t register. Elation crumpled into despair. “Nobody cares,” he thought. “Absolutely nobody cares.”

Hines soon hurdled a railing, stepped out onto a ledge 25 stories above San Francisco Bay and jumped. He immediately regretted it. Falling 75 miles an hour headfirst toward the water, Hines realized that if he was going to save himself, he had to hit feet first. So he threw his head back right before he plunged 80 feet into the cold waters, shattering two of his lower vertebrae. He eventually surfaced and was rescued by the Coast Guard. Only one out of 50 who jump survive.

Thirteen years removed from his attempt, Hines is now an author and lecturer, and doing quite well considering his experience. Hines frequently travels around the country talking about what happened on September 25, 2000. Diagnosed with bipolar disorder, he still has auditory and visual hallucinations as well as paranoid delusions. But today, he has a support network of family and friends that check up on him and identify early warning signs that could lead to Hines harming himself again. He logs his symptoms into an online document he shares with others so they can keep an eye on him. Hines says that’s what separates him from so many others who have suicidal thoughts.

“When you learn to be self-aware with mental illness, you can save your own life,” Hines says.

In May, the Centers for Disease Control released data showing that in 2010, 38,364 people weren’t able to save themselves. For the first time, the number of suicides surpassed deaths from motor vehicle accidents and most researchers believe that number is low, if anything, because many suicides go unreported. The suicide rate for Americans aged 35 to 64 rose 28.4 percent from 1999 to 2010. According to the CDC, $35 billion is lost due to medical bills and work loss costs related to suicide each year. And while suicide rates are not as high as they were in the early 1990s, they’ve climbed steadily upward since 2005.

As more Americans commit suicide, some in the field question the effectiveness of current prevention programs. Over the last 15 years, public policy and federal funding have shifted toward a broader mental wellness movement aimed at helping people deal with anxiety and depression that could eventually lead to suicidality. But that shift may have left those most at-risk of suicide, like Hines, without the support they need.

One program sits at the intersection of those two approaches. The National Suicide Prevention Lifeline, which expects 1.1 million to 1.2 million calls this year and receives about 15 percent more callers each year, is broadly marketed to the general public through billboards and ads that reach those suffering from anxiety, depression and loneliness but are often not actively suicidal. At the same time, it’s an emergency resource for those who are at immediate risk of killing themselves and who struggle with chronic mental illness. But some in the field question its effectiveness, along with the effectiveness of many other services and programs funded and promoted on a national scale. Those in the field often use the metaphor of a river to illustrate the divide: Is it worth getting to more people upstream or narrowly targeting those like Hines downstream?

At the Waterfall

The bridge phone inside New York City’s suicide prevention call center only rings about once a month. But when it does, often in the middle of the night, it emits distinct, deep chirps – as if the phone itself is in distress. The operators manning the 24/7 LifeNet hotline recognize the ring immediately. It means someone’s calling from one of the area’s 11 bridges, and they’re likely thinking about jumping.

LifeNet, a suicide prevention hotline servicing New York’s metropolitan area, also serves as one of 161 call centers that make up the National Suicide Prevention Lifeline network, headquartered in the same building. During its busiest hours from 9 a.m. to 7 p.m., the hotline has roughly 20 operators working the phones inside their unassuming L-shaped office space in lower Manhattan. The operators could easily be mistaken for a collection of telemarketers. The large computer screen at the head of the call center showing the number of lines being processed could easily reside inside QVC’s customer service center.

You don’t get a sense of what truly happens in this room until you run across the bridge phone, which is a direct line to the call center. It’s LifeNet’s equivalent of the Oval Office’s mythical red phone. On the wall above it, black Ikea picture frames display detailed information for each bridge and the locations of its call boxes: “Northbound 3rd Avenue Exit,” “Westbound Light Pole 60.” If someone calls, they can use the caller ID, check the information above the phone and immediately locate the caller and send help.

If it were up to those who work at LifeNet, however, they would get rid of the bridge phone altogether. “What we want is to get people upstream,” says John Draper, director of the National Suicide Prevention Lifeline. “We don’t necessarily want to get people who are on the edge of the waterfall. If they are, we can help them. But it’s a huge cost savings for the entire mental health system if you can get people further upstream.”

Draper is the National Suicide Prevention Lifeline’s soft-spoken, goateed, pony-tailed director and a whole-hearted advocate for early treatment. Talk to him and you realize why he’s in this field, something, he says, chose him. Draper speaks calmly but with purpose. He looks you in the eye. He routinely uses your name in conversation.

In the 1980s, Draper was part of a mobile crisis team, a group of clinicians that goes into the homes of people who are psychiatrically ill but unable or unwilling to get help. He says he soon came to the realization that the country’s mental health system operated behind bricks and mortar, “where it waits for people.”

“It says, ‘Ok, you’re mentally ill?’ I’ll see you Tuesday at 9 a.m. Hope you can make it.’ The system is not set up for the convenience of the user,” he says. “And as a result, two-thirds of the people with mental health problems in this country never seek care. So here was this program that goes into people’s homes. I was like, man, this is the way it should be.”

A decade later, the Mental Health Association of New York City established a 24/7 crisis information and referral network and hired Draper. Several years later, the Substance Abuse and Mental Health Services Administration (SAMHSA), which is part of the U.S. Department of Health and Human Services and now partially funds the national lifeline, assessed callers who had contacted crisis centers like New York’s and found that most of them felt less distressed emotionally and were less suicidal after the call. Draper calls it a groundbreaking finding.

LifeNet came into its own in 2001 when it became a central resource for those affected by the Sept. 11 terrorist attacks, which in New York City was just about everybody. People were reporting depression, anxiety and other traumatic responses in massive numbers. LifeNet’s call volume and staff doubled, and it’s never gone down. That time in the spotlight positioned the hotline to administer the national suicide prevention lifeline starting in 2004.

Today, Draper and his staff oversee more than 160 networked call centers around the country. Call 1-800-273-TALK, and you’ll be routed to the call center closest to the phone number from which you’re calling. The staff, funded with $3.7 million a year by SAMHSA, helps develop risk assessment standards for operators around the country so they can consistently and quickly determine the seriousness of a situation over the phone.

Draper expects call volume to increase again this year. About 8 million adults in the U.S. are thinking seriously about suicide, but only 1.1 million actually attempt it. So when Draper sees the volume actually reaching that 1.1 million number, which he expects it to this year, he views it as a good thing.

“If your calls are increasing, does that mean more people are in distress?” he says. “That’s not necessarily true. It means more people may have been in distress all along but didn’t know this resource was there. So the more we promote awareness of this resource, once it gets out, then it stays out there.”

The problem for people like Draper is definitively determining whether suicide prevention efforts are working. The only way you ever know if you’re saving someone’s life is if they come out and say so, and that makes it difficult to truly gauge the effectiveness of the lifeline or any other prevention program or service.

“The lifeline is a valuable addition to our efforts,” says Dr. Lanny Berman, executive director of the American Association of Suicidology (AAS). “It’s indeed a resource for people in suicidal crisis to reach out immediately and get help. Whether it is effective in saving lives remains to be seen.”

But some of the available data seems to indicate that the lifeline is having a positive effect. Studies done by Columbia University’s Dr. Madelyn Gould have found that about 12 percent of suicidal callers reported in a follow-up interview that talking to someone at the lifeline prevented them from harming or killing themselves. Almost half followed through with a counselor’s referral to seek emergency services or contacted mental health services, and about 80 percent of suicidal callers say in follow-up interviews that the lifeline has had something to do with keeping them alive.

“I don’t know if we’ll ever have solid evidence for what saves lives other than people saying they saved my life,” says Draper. “It may be that the suicide rate could be higher if crisis lines weren’t in effect. I don’t know. All I can say is that what we’re hearing from callers is that this is having a real life-saving impact.”

[…]

You may think that a suicide prevention office would be a dreadful place to work, but it’s really just like any other around the country: idle chatter near the water cooler, lunch breaks with co-workers, cinnamon rolls in the break room. It’s just that from this room, lives are being profoundly affected every day. And even though the exact number of people who have truly been helped will never be known, the lifeline has very strong advocates, including Kevin Hines.

Hines’ story is not merely dramatic; it’s a test case in how the mental health system broke down. There are essentially three main ways to prevent suicide: treatment; means prevention; and access to prevention resources. At the time, Hines wasn’t properly being treated for bipolar disorder; the Golden Gate Bridge has no physical barriers to prevent suicide attempts; and as for the bridge’s suicide prevention call box, Hines didn’t know it was there.

Had I known, I’m sure I would’ve called,” he says, “because I desperately wanted to talk to somebody.”

Back in New York City’s suicide prevention call center, I ask Draper if it’s difficult to come in to work each day, to motivate his employees to take another call and assure them that what they’re all doing is actually working.

“When I tell people what I do, they say, ‘Oh, Draper, that must be really depressing,’” he says. “And I say, man, I’m in the suicide prevention business, not the suicide business. What I see every day and what our crisis center staff hears every day is hope. And they know that they’re a part of that.”

He says it’s important to remember that 1.1 million adults are attempting suicide every year, but 38,000 are actually dying by suicide.

What that is telling us is that by and large, the overwhelming majority of suicides are being prevented,” he says. “And those stories are not being told.”

Read the whole story at: http://healthland.time.com/2013/09/13/inside-the-national-suicide-hotline-counselors-work-to-prevent-the-next-casualty/#ixzz2es8LLygE



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[Article of Interest] Mental health needs realistic treatment – or we face decades of wasted timeBy Rich McEachranNGOs can play a decisive role in ensuring that those with mental health problems aren’t misdiagnosed, and receive treatment that takes cultural and educational barriers into accountThe United Nations regularly declares that “there is no health without mental health.” It’s a statement that holds much truth, yet little meaning in relation to mental health’s standing in the development sector and governmental policies.About 13% of all global illnesses are said to be related to mental health, and in low and middle-income countries it’s reported that up to four in five people fail to receive proper treatment or care. This, combined with the fact that a majority of the developing countries dedicate less than 2% of their health budget to mental health care, is a reflection of how inadequate awareness of the issue is.NGOs can play a decisive role in ensuring that those with mental health problems aren’t neglected; they can help rebuild community resilience, develop relationships between patients and carers, or those administering treatment, and create greater awareness of mental health issues. Understanding mental health as a disability is beneficial. Yet, even organizations who work with the world’s 1 billion disabled population can often fail to deal with disability at a macro-level – for example, lack of awareness of the issue in their literature – so mental health as part of field work, at a micro-level, is vulnerable to being mismanaged too. This mismanagement is partly the result of a lack of comprehensive data and the way data collation is implemented.Trying to reach some of the most vulnerable people in society, many of whom are unwilling to talk sue to the stigma of their conditions, is tricky. The situation can be made worse if a patient has acquired sensory problems, such as difficulty speaking. Finding common ground and ways to develop universal forms of communication can provide a strong basis to carry out research, collate data and to even help deliver better treatment to patients. Mobile and SMS technology, for instance, has become a vital tool in reaching out to people in low resource environments and who otherwise might be inaccessible.”In Kenya, for example, there is one psychiatrist for every 500,000 people and one psychologist for every 1 million people. However, we have the mobile phone, whose penetration in Kenya is 74% … smartphone usage is steadily growing too,” says Gladys Mwiti, founder of the Oasis Africa Centre for transformational psychology & trauma expertise.The centre is currently collaborating with the Women’s College Research Institute, at the University of Toronto, on a mobile app that will provide information for adult survivors of child abuse and neglect. The app will focus on trauma and its impact, personal trauma management, links to professional care and coping with and knowledge of on-going trauma management and resiliency building.The project has recently applied for a grant from the Canadian government, though generally, funding hasn’t been easy to come by – a situation that isn’t uncommon for any development project looking for financial backing. Mwiti does forecast a change in attitude though. “Indeed, development agencies are beginning to believe that without mental health, years of grant activities in Africa will only produce wasted decades unless holistic solutions are realised,” she says.How then can western-based NGOs implement holistic solutions, and how practical would they be? Failure to do this efficiently could lead to NGO employees entering a foreign country without a suitable grasp of the language or cultural differences, and ending up introducing westernised treatments that don’t compute and misunderstand local attitudes, such as a trauma patient being possessed by a devil. Not understanding the local context is also true of southern NGOs who may have an “urban bias” and to whom the cultural practices in rural areas a completely foreign."Language is definitely a barrier. Terms which seem simple to us, such as ‘depression’ or ‘trauma’, may not translate easily," says Natalie Mehrgott, a psychotherapist who has worked in Kampala and Lusaka and has first-hand experience of dealing with trauma patients and refugees."Experimenting with words that [patients] may better relate to could help overcome these barriers; like substituting ‘depression’ for ‘sadness’. I also find focusing on body language can ease the process of dealing with patients who have difficulty communicating – especially hand gestures. When talking directly about ‘depression’ or ‘trauma’ I may clench my fist against my chest and then rub my eye with the other hand as if I were wiping away a tear."Treatment can be a bit of a misnomer, particularly if it’s poorly thought out and fails to communicate sympathetically with the patient. Mehrgott indicates that it could do more damage than good and can reinforce the problems that it’s trying to address. Adopting simpler language and hand gestures can be ways to actively work with the wider community too. Improving how locals perceive mental health is imperative to how patients may see themselves and understand their condition. At the same time, treatment can also become a bit of a distraction if NGOs fail to realize that mental health problems aren’t just symptomatic of conflict or post-traumatic stress disorder. Even though mental health is closely linked to events such as war, it shouldn’t be assumed that they have caused the health problem. Rather the situation patients find themselves in makes them more pronounced.Realizing the complexities of mental health is critical to understanding how it coalesces with poverty, education, employment, general health and conflict itself. By doing this and acknowledging cultural sensitivities and potential language barriers, NGOs can work towards realistic holistic solutions that can provide relief to mental health patients.

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[Article of Interest] Mental health needs realistic treatment – or we face decades of wasted time
By Rich McEachran

NGOs can play a decisive role in ensuring that those with mental health problems aren’t misdiagnosed, and receive treatment that takes cultural and educational barriers into account

The United Nations regularly declares that “there is no health without mental health.” It’s a statement that holds much truth, yet little meaning in relation to mental health’s standing in the development sector and governmental policies.
About 13% of all global illnesses are said to be related to mental health, and in low and middle-income countries it’s reported that up to four in five people fail to receive proper treatment or care. This, combined with the fact that a majority of the developing countries dedicate less than 2% of their health budget to mental health care, is a reflection of how inadequate awareness of the issue is.
NGOs can play a decisive role in ensuring that those with mental health problems aren’t neglected; they can help rebuild community resilience, develop relationships between patients and carers, or those administering treatment, and create greater awareness of mental health issues. Understanding mental health as a disability is beneficial. Yet, even organizations who work with the world’s 1 billion disabled population can often fail to deal with disability at a macro-level – for example, lack of awareness of the issue in their literature – so mental health as part of field work, at a micro-level, is vulnerable to being mismanaged too. This mismanagement is partly the result of a lack of comprehensive data and the way data collation is implemented.
Trying to reach some of the most vulnerable people in society, many of whom are unwilling to talk sue to the stigma of their conditions, is tricky. The situation can be made worse if a patient has acquired sensory problems, such as difficulty speaking. Finding common ground and ways to develop universal forms of communication can provide a strong basis to carry out research, collate data and to even help deliver better treatment to patients. Mobile and SMS technology, for instance, has become a vital tool in reaching out to people in low resource environments and who otherwise might be inaccessible.
In Kenya, for example, there is one psychiatrist for every 500,000 people and one psychologist for every 1 million people. However, we have the mobile phone, whose penetration in Kenya is 74% … smartphone usage is steadily growing too,” says Gladys Mwiti, founder of the Oasis Africa Centre for transformational psychology & trauma expertise.
The centre is currently collaborating with the Women’s College Research Institute, at the University of Toronto, on a mobile app that will provide information for adult survivors of child abuse and neglect. The app will focus on trauma and its impact, personal trauma management, links to professional care and coping with and knowledge of on-going trauma management and resiliency building.
The project has recently applied for a grant from the Canadian government, though generally, funding hasn’t been easy to come by – a situation that isn’t uncommon for any development project looking for financial backing. Mwiti does forecast a change in attitude though. “Indeed, development agencies are beginning to believe that without mental health, years of grant activities in Africa will only produce wasted decades unless holistic solutions are realised,” she says.
How then can western-based NGOs implement holistic solutions, and how practical would they be? Failure to do this efficiently could lead to NGO employees entering a foreign country without a suitable grasp of the language or cultural differences, and ending up introducing westernised treatments that don’t compute and misunderstand local attitudes, such as a trauma patient being possessed by a devil. Not understanding the local context is also true of southern NGOs who may have an “urban bias” and to whom the cultural practices in rural areas a completely foreign.
"Language is definitely a barrier. Terms which seem simple to us, such as ‘depression’ or ‘trauma’, may not translate easily," says Natalie Mehrgott, a psychotherapist who has worked in Kampala and Lusaka and has first-hand experience of dealing with trauma patients and refugees.
"Experimenting with words that [patients] may better relate to could help overcome these barriers; like substituting ‘depression’ for ‘sadness’. I also find focusing on body language can ease the process of dealing with patients who have difficulty communicating – especially hand gestures. When talking directly about ‘depression’ or ‘trauma’ I may clench my fist against my chest and then rub my eye with the other hand as if I were wiping away a tear."
Treatment can be a bit of a misnomer, particularly if it’s poorly thought out and fails to communicate sympathetically with the patient. Mehrgott indicates that it could do more damage than good and can reinforce the problems that it’s trying to address. Adopting simpler language and hand gestures can be ways to actively work with the wider community too. Improving how locals perceive mental health is imperative to how patients may see themselves and understand their condition. At the same time, treatment can also become a bit of a distraction if NGOs fail to realize that mental health problems aren’t just symptomatic of conflict or post-traumatic stress disorder. Even though mental health is closely linked to events such as war, it shouldn’t be assumed that they have caused the health problem. Rather the situation patients find themselves in makes them more pronounced.
Realizing the complexities of mental health is critical to understanding how it coalesces with poverty, education, employment, general health and conflict itself. By doing this and acknowledging cultural sensitivities and potential language barriers, NGOs can work towards realistic holistic solutions that can provide relief to mental health patients.

For more mental health news, Click Here to access the Serious Mental Illness Blog

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