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Tag Archives: mental health

When Progress Falls Short

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New York State is passing new gun regulations. They are the first to do so after the 2012 Newtown (Connecticut) school shooting. The legislation will be lauded for its expanded ban on assault weapons and a broader definition of those weapons. The part of the legislation that will probably get the least attention the mention of mental illness. We seem to agree (subconsciously at least) that massacring innocent people is not the work of a sane individual. We also collectively agree that there are many many people struggling with their thoughts and feelings every single day. Most of us would agree that if we have a mental health system in this country to speak of, it is filled with holes and dead ends. So any legislation that even begins to address the mentally ill is a good thing, no?

Not when the legislation is a directive to mental health practitioners to report patients who are going to harm themselves and others, allowing the authorities to then remove guns from that patient’s home. Talk about your paper tigers! If people struggling with mental illness had access to a practitioner we’d have reason to celebrate! If mental health practitioners could predict who will cause harm we would be living in a very safe world indeed. A person is determined to be a danger to him/herself or others when the patient says that he or she is a danger to him/herself or others. So this ‘dangerous’ group is now a minute percentage of the actual group of potentially dangerous people. Now compound that with the fact that this new legislation might deter someone with any hint of paranoia or delusion from seeking mental health support. Add to that mess the fact that the shooting that prompted this legislation was done with weapons belonging to the murderer’s mother, not the man himself. You see how this might be more smoke than substance?

This could and should be the opportunity to decree that people haunted by their thoughts and impulses should not have to work so hard to get care. This is our chance to say that mental illnesses are complex and challenging to treat, but so is cancer and like cancer we need to go at it with everything we’ve got. Right now before the voices or the rage or the hopelessness cause a person to lash out on a subway platform, or slash someone on the street or shoot a toddler with a handgun or burn down a home; is when we should say that decent people do not allow this to continue. Decent people know that when we choose to not fight for those that need us most we forever must bear some responsibility for the consequences. Decency doesn’t allow for empty gestures or placating. There is no doubt that any restriction on guns is good for our country, and this legislation makes an impact on that goal. The public may very well applaud the creators of this legislation. There may be pats on the back and a nice sense of achievement. But at the end of the day the authors of this legislation know that they missed a golden opportunity to make real, humane and lasting change and may have stalled whatever building momentum there was to do so.

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Posted by on January 15, 2013 in Cultural Critique, Well-Being

 

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A Chance For Happy Days

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Adolescence is not fun or pretty. There is nothing “How lovely to be a woman” or “I am 17 going on 18” about it. It’s a wretched maelstrom of physical and emotional change. Everything feels chaotic and unending and there’s not enough life experience to offer a glimmer of hope. This is why teen suicide is so very tragic. No one would deny a teen’s real and crushing psychic pain. But we would probably challenge them in their sense of permanency. ‘Wait’ we collectively say; ‘it gets better.’ And we mean it, and it’s likely to be true. For some time the news of teen suicides has be packaged with pleas for adolescent mental health care. Articles and news desk pundits tell us how to identify a child in crisis and where to get help. But today’s news that 55% of suicidal teenagers had received mental health care is jarring. Yes, there are still 45% of suicidal teenagers not receiving care. But the majority of teens in crisis are getting help. Therapy is tricky business of course. Finding the right therapist for a patient can be challenging. Finding gifted and accessible adolescent specialists can be tough. Prescribing just the right medication to someone who isn’t growing and changing daily is difficult. Monitoring the taking of medication is…well if you’ve ever met (or been) a teen, you know how crafty they can be.

Whether we think that ending one’s life is a personal choice is irrelevant when it comes to adolescents. We may believe that grown people who have exhausted themselves and every option to alleviate their physical and/or psychic pain are entitled to just stop, but that’s not applicable to discussions of children. Teenagers are by definition closer to children on the maturity spectrum. They simply don’t have the life experience or fully developed brain to make such a decision. There are teens who have serious physical and/or mental health issues. There are teens who’ve witnessed or been victims of horrific acts. If they were middle-aged people still suffering intensely this would be a different conversation. But they are teenagers. They are not allowed to drink, vote, live alone or rent a car. They are simply incapable of making a rational terminal decision.

So what can be done? We know that boys are more ‘successful’ at attempts than girls. We also know they tend to be more violent overall. Unfortunately it does not go without saying that there should never be weapons in a home that includes children. There also should be no access (no guns or other weapons in cars, workplace, sheds, trailers, etc.) No weapons ever. There needs to be talking lots of talking. Most teens are sullen and uncommunicative at times, but adults should not be. Your teen may be bigger and stronger than you, but you are still the adult. If your child is more sullen than not, and/or has lost interest in activities (did he/she quit a team or a friend?) tell the school’s administration and teachers. The more people watching out the better. If the child is utterly noncompliant (won’t come out of room, won’t go to school, etc.) it’s time to involve more people and perhaps inpatient care.

It’s hard to think of an adult-ish appearing person with a full vocabulary as a child. But they are. For some purposes a teenager is more akin to a newborn than an adult. They are on the brink of learning an entirely new way of engaging with the world. They are often frightened of leaving the security of the home and entering the world on their own. We, (i.e., all adults in a teens life) must think back to how we scrutinized every movement and development in their newborn lives. We must revert back to the parenting that intervenes when something seems off. It’s frightening to challenge anyone let alone your child who makes your heart ache. It’s scary to exert authority over someone who might be larger then yourself. It’s terrifying to think that you might say the wrong thing; the thing that will actually drive him/her over the edge or out of your reach. Silence never saved anyone.

 
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Posted by on January 9, 2013 in Childhood, Well-Being

 

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An Illness In The Family

 

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Periodically, most often prompted by crisis, mental health pops up in our cultural conversation. Pundits point out the obvious flaws in our care system, medical professionals speak of conflicting and vague diagnostics, and some families share heart wrenching personal tales. This flurry of post-crisis activity is actually a microcosm of the complex issues of mental health care: People state the obvious, others admit to the complexity and the people in need are suffering.

Family members (and by ‘family’ we mean everyone who shares love) are often in the direct line of fire of mental illness. Their lives can be upended by the illness of a loved one and their every moment consumed with pursuing effective care. It is those closest to someone ill who will witness and be subjected to troubling behaviors. And unless the ill person is a minor or the behaviors so blatantly outrageous, it is difficult to judge when it’s appropriate to intervene and to what extent. We are a culture that holds personal freedom and autonomy in the highest regard. And while we like to tell people what to do with their lives in the abstract, we shrink from doing so in reality. We don’t want to unnecessarily offend and even if we did, it’s difficult to know what to say or do. It might be helpful to think of behaviors and approaches categorically.

Danger to self or others – There’s no wiggle room here. Our society has agreed that impending physical harm trumps personal freedom. While the “danger to self or others” definition is meant to be applied in crisis, the philosophy applies more universally. When asking ourselves; “Is it time to seriously intervene?” we can use this statement as a guide. It is time to move on from nagging and/or cajoling a family member to eat when you see/feel that their weight loss is dangerous. If someone is driving when drinking, passing out and/or injuring themselves when drinking, they are a danger. If someone cannot get out of bed and has vulnerable people in his/her care he/she is a danger. The question to ask when making this judgment is; “Is someone going to get hurt?”

In crisis is probably the most common presenting challenge. There is no immediate danger but instead a person who is simply not well. For the most challenging mental illnesses (i.e., schizophrenia, bi-polar, personality disorders) a state of crisis is a common occurrence. For people faced with depression or anxiety, crises can be one-offs or few and far between. Depression is a real and debilitating illness, it should not be confused with sadness. Being sad is prompted by incident: a death, a world event, a hormonal event all can trigger sadness. Of course these events can also trigger depression. The key is how long is the darkness lasting and has it changed the very nature of the individual? The same is true for anxiety. When a response to real and present danger morphs into sustained hyper-vigilance it is not serving the individual well.

Intervention – Erase any image you might have of corralled family members confronting someone while shakily holding index cards. It’s a powerful scene for television and movies but is flat out surreal in real life. If there are other caring people who can assist in getting the person in need appropriate care, so be it. But folding chairs and prepared statements are not necessary. If the person is in crisis (danger to self or others) they need immediate professional assistance. If someone has demonstrated a desire to hurt themselves or others they can and should be hospitalized and treated until they are stable. If the person in crisis is compliant you can take them to an emergency room yourself. If they are violent the police will help them to the hospital. *Note: It is best to assume that each and every threat of harm is valid. There is nothing to gain from assuming someone is crying wolf. If nothing else the emergency room staff will become more familiar with the person in crisis and be able to provide more specific care with each return trip.

For people not in crisis, intervention can be a hairy and anxiety provoking business. Every situation, relationship and individual is different. There are no universal guidelines on what to do, but there are some pretty clear guidelines on what not to do. Do not make it easy for someone to not get help. Do not take on the role of amateur therapist. Do some research and find a therapist in the right price-range (any doctor’s office, school, women’s health clinic, or divorce attorney will have referrals.) When the individual seeks to emote or purge have a contact number on hand and take full responsibility; “I want to help in a meaningful way, I’m your friend/family but not a therapist.” If an individual refuses professional help do not abandon them but do not engage in the fiction (i.e., “it’s just a phase, the season, pesticides, politics, etc.) Keep in mind that they are not entirely themselves and may not be the most reliable narrator. Bring them into the world (perhaps kicking and screaming.) Do not sit by their side and watch television. Go for a walk; remind them of the world they’re missing out on. Do not lose sight of the goal of professional help. Do not give up until you’ve exhausted every argument and yourself.

Someday we will treat mental health as we do dental or physical health. Blame and shame will dissipate and systemic effective care will be available to all. Family (in all its definitions) will always be at the front, but in time they will have proper support. There simply is no sane alternative.

 
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Posted by on January 7, 2013 in Cultural Critique, Well-Being

 

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It’s All About We

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Individual freedom is at an all-time high in our country. It’s actually been on the rise for quite sometime. You may be old enough to recall the ‘Me’ generation. Elders were alarmed to see the younger folk intone that ‘greed was good.’ There was hand wringing and prophesying that our nation was going to hell in a hand basket. Many of the beleaguered moaners had been genuine placard carrying protesters and sitter inners. “What means this ‘in it for me’?” the asked. How can those so young be so cynical they wondered? But in many ways this new generation was just a product of social evolution. Their values seemed alien on the surface, but at their core they were really quite familiar.

The individual and the declaration of his/her pursuit of happiness is as old as, well, as our nation. It’s what constitutes happiness that has changed over time. Our individual rights, many of them the result of hard won fights by protesters and sitter inners, have brought a new reality. One need only take a quick look around to see how we have changed our orientation to the larger world. It is not one single thing, but the mosaic of; S.U.V.s, double-wide strollers, texting while walking, driving or in religious service, grooming or performing personal hygiene in restaurants, standing in the doorway of the subway car, letting doors slam on faces and behinds, that lead us to consider that the individual now reigns supreme.

There is much to say for individualism of course. It is a sign of creativity and a self-actualized life to stay true to oneself. But there is tricky terrain to tread when we consistently choose our individual rights over the collective good. Legally we have the right to arm our entire family and ourselves as if the British are coming. We also have the legal right to shelter our children from public services and mental health care. Do either of these individual rights benefit society in any way?

Legal rights are designed for the betterment of society. They reflect our collective ideals and values. Is enacting law a panacea? No, but it’s a start. It’s true that seat belt laws don’t make good drivers, but they might just protect you from the bad ones. What car laws do (and we have many of them) is say; “No, your individual rights cannot infringe upon the rights of others.” All reasonable people can agree that in fact that is where we draw the line.

No, you may not own any and every kind of gun you desire because doing so infringes upon the rights of others. No, you may not deny your child care and support because doing so infringes upon (his/her and the) rights of others. We must collectively provide such care and support with a fervor. We must remove the stigmas and euphemisms surrounding mental illness. We must agree that the only shame in any illness is that of a culture that doesn’t care. If we care, we must find a way to move on from the ‘Me’ and towards the ‘We.”

 
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Posted by on December 20, 2012 in Childhood, Cultural Critique, Well-Being

 

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Mental Health In Crisis

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During the first few hours after the school shooting in Connecticut there were vague and conflicting reports. The shooter was still being misidentified as the first rumblings of mental health issues began to surface. Amateurs and professionals began to pontificate on the need for meaningful support for first responders, victim’s families and witnesses. We have become much more comfortable in acknowledging the profound psychological impact of trauma. We can look at a (massively media covered) tragedy and think; “ah yes, this will have an impact.” What we have a bit more trouble discerning is mental health challenges that may not stem from widely covered events. We are also a bit challenged in trying to foresee lasting effects.

Our first thought when hearing about murdered children is about their parents. If we’ve been lucky, it is beyond our first hand comprehension. It is simply unfathomable to lose a child let alone in such a horrific manner. The parents’ lives, now unrecognizable to themselves, are forever marked by this loss. Our minds grasp for any detail that we can construe as offering comfort. Are there surviving siblings, someone to motivate the parent to go on? And then we remember that while it is a gift to survive it is a burden as well. The siblings, no matter their age, will forever be survivors. They will feel that label and internalize it in varied ways. Even siblings not yet born will wear that identity. It could color (and potentially burden) their entire lives.

Similar survivor issues may well develop in adults and children who could have been included in the count. It is tempting to not give survivor mental health issues the attention they warrant. These people still have their lives after all. But if we’ve learned anything from this (and other) barbaric acts it is that mental health care cannot be ignored. Many will need and should have access to a lifetime of mental health support. In the coming days we will learn more about the perpetrator and the details leading up to the massacre. We will demand serious and desperately needed real gun control. We will light candles and say prayers. And we must, if we hope to ever live in a humane world, give mental health care the respect and importance it deserves.

 
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Posted by on December 15, 2012 in Well-Being

 

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