Categories
Depression

Praying Away the Sadness: The Nuanced Link between Spirituality and Depression

Initial results from a study published by Cambridge University Press present extremely nuanced findings regarding the relationship between depression and religion. In cases where individuals were intrinsically motivated to practice their respective religion, their faith served as a preventative measure for symptoms of depression. People who practiced their faith and felt accepted in their own respective religious communities were found to be at less of a risk for depressive symptoms. Additionally, people who did not practice religion at all were found to be at more of a risk for depression than the individuals who were intrinsically motivated to practice. Perhaps the most interesting finding of this study is that people who were already exhibiting depressive symptoms generally were at more of a risk for clinical depression when surrounded by people in their respective religious communities.

The reality of the situation is that oftentimes, depression, in particular, is extremely stigmatized in religious communities. In many religions, particularly monotheistic faiths, belief in God and the afterlife is supposed to be the ultimate coping mechanism for depressed thoughts. Focusing on the afterlife is supposed to make worldly concerns and problems seem more bearable. In addition, individuals who suffer from depression are often seen as “ungrateful,” or told that their faith is not strong enough. Beliefs in the suffering of prophets such as Jesus and Muhammad often add to this stigma. Individuals are told that their suffering can never compare to that of their prophet. As a result of this, people in the early stages of depression often have their feelings invalidated, which can lead to feelings of isolation and worsening symptoms.

There is also a certain level of self-stigma that goes along with depression in religious individuals. People take depression as an indication that their faith in God is not strong enough, and that there is something lacking in their prayer and beliefs. In addition, depressed individuals who struggle with suicidal thoughts tend to struggle even more, because suicide is considered a major sin in most monotheistic religions.

Religious individuals have been shown to be even more reluctant to receive mental health treatment than the average individual. While this is mostly due to stigma, this problem could also be due to the lack of mental health professionals that openly identify with their faith. Religious people might feel more comfortable talking to a counselor that is of the same faith as them and understands their concerns, and many counselors do not specify their religion or are not particularly religious.

Overall, changes need to be made in both religious communities and in mental health treatment to make getting help for religious individuals more accessible and less stigmatized. Depression should not be attributed to a lack of faith, and the focus should shift to the religious community coming together to support the individual through love and acceptance. In addition, more openly religious mental health professionals need to be present for counseling. In the meantime, counselors who are not religious should still be getting at least some form of training on how to better serve the needs of more religious clients. If not, many individuals will continue to suffer in silence.

References:

McCullough, M. E., & Larson, D. B. (1999). Religion and depression: a review of the literature. Twin Research, 2(02), 126-136. doi:10.1375/twin.2.2.126

Mir, S. (2014). Muslims and depression: the role of religious beliefs in therapy. Integral Psychological Therapy, 2(2).

Petts, R. (2008). Religion and adolescent depression: the impact of race and gender. Review of Religious Research, 49(4), 395-414.

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Depression

Hate Crimes and Depression

Dr. Prabhjot Singh, a Sikh-American man, was walking down a New York City street one morning in 2013, minding his own business. Suddenly, a group of men came out of nowhere, yelling at him, calling him “Osama” and “terrorist.” The harassment did not end there. The group of young men punched Dr. Singh repeatedly in the face, ultimately breaking his jaw. Over the next few weeks, Dr. Singh reached out to the mental health services at his university but did not receive the support or attention he needed.  He found these services ill-suited for his needs, given that they were geared towards people with more severe mental illnesses.

Over the next few months, Dr. Singh’s attack got significant media attention, and before long, his inbox began piling up with messages from people whose relatives or friends had experienced hate crimes of a similar nature. They were looking for comfort, and most of all, support. Four years later, Dr. Singh still receives these messages. Over time, through reading these countless emails, Dr. Singh has slowly realized that although there is a growing number of people experiencing hate crimes due to the recent administration changes, there is a significant lack of resources tailored specifically to these individuals.

In the recent months, there have been increasing levels of distress among individuals targeted by President Trump’s campaign, specifically Muslim, LGBTQ, and Latino Americans. Muslim Americans, in particular, have been going through a rough time in recent years. They have dealt with the aftermath of 9/11, the 2015 Paris attacks, and Trump’s election, inauguration, and subsequent Muslim ban. The two major surges in anti-Muslim hate crimes have occurred directly after 9/11, and now, directly after Trump’s election. According to the Family and Youth Institute, which studies the mental health needs of American Muslims, there have been increased instances of anxiety and depression since Trump’s campaign began. There has also been an increase of Muslims seeking therapy and treatment, which is extremely significant because mental health is often stigmatized in Muslim communities. The fact that people are still seeking help, even in the face of this stigma, is proof that there is something seriously wrong.

Although Muslims, in particular, are experiencing increased aggression, there has also been a recent rise in hate crimes against LGBTQ individuals, African American individuals, and individuals of  Latino descent. In addition, people are becoming less specific with their hatred and instead extending their bigotry and prejudice to encompass all American minorities. Just over two months ago, the Birmingham Islamic Society received an email directed towards all African Americans, Latino individuals, Muslims, Jews, and Hindus. The message was simple: “run or die.”

Hate crimes such as these have serious psychological consequences. In the short term, hate crimes can lead to fear and paranoia in the victim. However, over time, this can become a more serious problem. The victim can experience post-traumatic stress and is more likely to develop anxiety and suicidal thoughts. Hate crimes are often deeply destabilizing to the very core of an individual, which is why they have such serious ramifications.

If victims of these crimes are not supported, the trauma from their attack often manifests into a more serious form of depression. Resources need to be established so that victims of hate crimes can receive more solid support in order to prevent their mental health from deteriorating once they or someone they know gets attacked.

One type of resource that has proven to be valuable in the past is a support group for victims of hate crimes. Staff at a YMCA in western Michigan established a weekly therapy group for individuals who were not only direct victims of hate crimes but knew someone who experienced a hate crime. This group also supported people who felt victimized by the policies of the recent administration.

Programs like this are extremely effective but are currently few and far between. People like Dr. Singh are working to bridge this gap. Dr. Singh, along with Dr. Sameera Ahmad, is working with the Council on American-Islamic relations in order to develop more training programs and support groups for Muslims dealing with hateful rhetoric. This is a step in the right direction, and hopefully, in the future, more programs like this will be created and implemented for all minorities experiencing hate crimes.

References:

Latvian Centre for Human Rights. (2016). Psychological Effects of Hate Crime. Retrieved from http://cilvektiesibas.org.lv/site/attachments/30/01/2012/Naida_noziegums_ENG_cietusajiem_Internetam.pdf

The New York Times. (2017, April 17). When Hate Leads to Depression. The New York Times.

The New York Times. (2017, April 30). Spread of Hate Crimes Has Lawmakers Seeking Harsher Penalties. The New York Times.

Pew Research Center. (2017). Anti-Muslim assaults reach 9/11-era levels, FBI data show | Pew Research Center. Retrieved from http://www.pewresearch.org/fact-tank/2016/11/21/anti-muslim-assaults-reach-911-era-levels-fbi-data-show/

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Depression

Dying a Lovely Death: The Glamorization of Depression

Imagine this: You wake up every morning with an ache in your chest. You haven’t showered in three days, because you’re too mentally exhausted to wash the grease from your hair, let alone function as a normal human being. You’re sitting in class but the teacher’s words are meaningless, distant, and indistinct. You feel this constant emptiness in your chest, and you feel like crying, but you don’t know why.

You’re nervous. You’ve been fourteen minutes late to school every day this week, with no explanation for your tardiness except that you couldn’t get out of bed. Your mind cycles through a seemingly endless spiral of irrational thoughts, and you’re just tired. This is the harsh reality of the cycle of depression.

Imagine this: You go online looking for solace, a place where you can feel like you belong, a place where you can feel loved. You see a girl in a black and white photograph with perfectly tousled hair, eyeliner artfully smeared across her cheeks, and smudges of violet underneath her eyes. The caption on the photo describes how suffering is beautiful, how depression is “mysterious.” You scroll further and find blogs about self-harm that present cutting as the best way to deal with your emotions. These posts ultimately convince you that suicide is the best option.

This is the sad reality that many young people have experienced in response to the rise of self-harm in depression blogs and content on social media.

Over the years, the conversation surrounding mental illness has experienced a profound shift. For much of the 20th century, mental illness was not addressed at all and was instead ignored and extremely stigmatized. As the decades went on, depression and other mental illnesses were brought to the forefront of public attention through celebrities who talked about their experiences with the disease. However, with the increased prevalence of social media, online communities have formed what are perpetuating ideas of “beautiful suffering”. This facilitates negative feelings and misunderstandings of what it means to be clinically depressed.

One of the main social media sites that has perpetuated the idea of depression being “beautiful” and “mysterious” is Tumblr, a platform where social communities often form around specific topics. Individuals have their own blogs, and can quickly share images, photos, and other media through the act of “reblogging” a post. Individuals often form communities around different disorders seeking some form of support and acceptance. However, with depression, in particular, the culture on photo and video sharing websites like Tumblr and Instagram has shifted from supporting people who are clinically depressed to glamorizing ideas of sadness. Black and white photographs of mystical emaciated women who stare off into the distance put psychological torment and beauty on the same page. Quotes like “So it’s okay for you to hurt me, but I can’t hurt myself?” and “I want to die a lovely death,” try to justify self-harm. All this is at the tip of anyone’s fingertips: anyone can search tags like “self-harm,” “depression,” or “sadness,” and find thousands of blogs with a similarly distorted vision of what it means to be depressed.

In addition to perpetuating negative feelings, beautification of depression often leads to people taking the disease less seriously. People begin to blame the victim, and instead of accepting clinical depression as a chemical imbalance in the brain, people begin to believe that people with depression are faking it for the attention. People who self-harm, in particular, are often targets of these misconceptions. Instead of scars from self-harm being seen as cries for help, these injuries are misconstrued as superficial pleas for attention.

This glorification of self-pity, as well as victim blaming, takes away from the fact that depression is a very real, and often very debilitating mental illness that starkly contrasts with the pretty pastel photos on social media. The glamorization of depression only adds to the stigma surrounding the illness. Although it is a step in the right direction that many individuals are talking about depression online, we need to foster communities that talk about depression in a way that breaks down stigma instead of adding to it.  

References:

The Atlantic. (2013, October 28). Social media is redefining depression. The Atlantic. Retrieved from https://www.theatlantic.com/health/archive/2013/10/social-media-is-redefining-depression/280818/

Periscope | I Want to Die a Lovely Death: the Glamorization of Depression in Popular Culture. (n.d.). Retrieved from http://www.chsperiscope.com/perspectives/2015/02/16/i-want-to-die-a-lovely-death-the-glamorization-of-depression-in-popular-culture/

Tanner, E. (2015). Girls, Instagram, and the glamorization of self-loathing. Dissenting Voices, 4(1). Retrieved from http://digitalcommons.brockport.edu/cgi/viewcontent.cgi?article=1046&context=dissentingvoices

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Depression

Depression in the LGBTQ Community

It’s easy to assume that now is a good time to be an LGBTQ individual in America. It has been more than a year since the Supreme Court’s ruling in favor of same-sex marriage. According to a 2015 Gallup poll, 66% of Americans approve of same-sex relationships, which is a higher rate of approval than ever before. Mainstream culture has grown more accepting of LGBTQ artists, writers, and activists over the years. Even with the rise in hate crimes against minority individuals due to the Trump administration, there has been an outpouring of support for the LGBTQ community. These factors work together to create an illusion that everyone, everywhere can live the lives that they want and deserve when it comes to who they love.

Gabrielle Gladu tried to commit suicide at the age of fourteen, right before she entered high school. Over the years, Gabrielle had felt uncomfortable and disoriented with how masculine her body was, given how feminine she felt inside. Because she lived in an extremely conservative community, Gabrielle never really had access to information about LGBTQ individuals in her daily life. Her family, teachers, and friends were not very accepting of LGBTQ people, and growing up, her parents only mentioned the LGBTQ community with extremely negative connotations. Because of this, Gabrielle turned to the Internet, and to her surprise, found a community that was accepting of diverse sexuality and gender identities. Over the years, she slowly became more aware of the various possibilities for sexual attraction and gender identity. Gabrielle eventually ended up finding an identity that personally resonated with her, and came out as transgender to her friends and family, expecting the same support and acceptance that she experienced on the Internet. However, she was met with only rejection and shame. Her family never accepted her, and this alienation severely affected her mental health, which ultimately caused her to attempt suicide at such a young age.

Although Gabrielle was able to find a home with individuals that supported and loved her, for many LGBTQ individuals, this is often not the case. A study done by the CDC in 2016 showed significantly higher rates of depression in lesbian, gay, and bisexual teenagers. Over one-third of these individuals had been bullied in school over the past year, and almost half had considered suicide. About a third of these teenagers had attempted suicide in the last twelve months.

Higher rates of depression and suicidal thoughts are not just limited to young people in the LGBTQ community. Adults in the queer community are three times more likely to experience depression than their heterosexual counterparts. In a study done in the Journal of Homosexuality, there was substantial evidence for a highly elevated risk of suicidal ideation in LGBTQ individuals.

Despite the higher rates of depression and suicidal ideation in LGBTQ individuals, there has been relatively little attention and funding put into creating programs to improve mental health in the queer community. In 2001, the U.S. National Strategy for Suicide Prevention and the Institute of Medicine’s Reducing Suicide: A National Imperative reported gay, bisexual, and transgender individuals as an at-risk population, but provided little information about contributing factors to this epidemic. The study also did not address whether targeted interventions, prevention strategies or public health policies would be implemented to reduce suicide in this population. LGBTQ individuals with depression and suicidal ideation often face substantially more issues than their heterosexual counterparts due to the combined stigma that often comes with both their identity and mental illness. Traditional mental health counseling is sometimes not enough to address this multi-faceted issue. Although we have made significant progress towards breaking down the stigma and discrimination surrounding LGBTQ individuals, we are not at a point where the LGBTQ community feels completely equal and comfortable in our society. Until we get to that point, LGBTQ individuals will continue to experience harassment and stigma, and we need to be providing them with the resources they need to deal with the challenges they face.

References:

Almeida, J., Johnson, R. M., Corliss, H. L., Molnar, B. E., & Azrael, D. (2009). Emotional Distress Among LGBT Youth: The Influence of Perceived Discrimination Based on Sexual Orientation. Journal of Youth and Adolescence, 38(7), 1001-1014. doi:10.1007/s10964-009-9397-9

Creating Safer Environments for Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth and Families: Opportunities for School Mental Health Promotion. (2016). Mental Health Promotion in Schools, 131-155. doi:10.2174/9781681083230116020009

Haas, A., & Eliason, M. (2011). Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: Review and recommendations. Journal of Homosexuality, 58(1), 10-51.

The New York Times. (2016, September 8). For Gay and Transgender Teens, Will It Get Better? The New York Times. Retrieved from https://www.nytimes.com/2016/09/11/magazine/for-gay-and-transgender-teens-will-it-get-better.html

 

Categories
Depression

Postpartum Depression May Not Wait for the Delivery

At 6 and a half months pregnant, Mary Guest jumped to her death off the 16th floor of her parent’s apartment building.

Mary was a lively, accomplished woman. She worked at an elementary school in Portland, Oregon, helping children with behavioral problems. Her co-workers described her as compassionate, driven, and supportive. Her supervisor said he had never seen a teacher that was more gifted at attending to students’ needs.

When Mary found out she was pregnant, she was ecstatic. She had been struggling with severe depression all her life, but decided to discontinue her medication because her doctor told her there was a risk of harm to the fetus. She was under the close care of a psychiatric nurse throughout the duration of her pregnancy, who told her that she could call any time for a prescription.

However, the months went on, Mary became worried about the health of her fetus, despite reassurances from her doctor that her baby was completely healthy. Despite genetic testing and multiple ultrasounds that confirmed the health of the baby, Mary would spend hours online researching everything that could possibly go wrong. This obsession started out small, but soon began to torment her as her pregnancy progressed.

During the fifth month of her pregnancy, Mary resumed her antidepressants. However, she saw little improvement in her mood, and the medication didn’t seem to help with her irrational thoughts anymore. She became convinced that she was doing her child a disservice by living in this world, and this led to her demise.

Mary’s mother, Kristin, spoke openly about Mary’s depression and suicide. “We are totally convinced that in Mary’s mind, what she did was an act of love,” Kristin said in a statement to the New York Times. “That’s the only place from which Mary ever came. She was tormented that the child was going to have some serious problem, and felt it would be better not to bring this child into the world than to birth her and not be able to take care of her. We feel, rightly or wrongly, that if Mary had stayed on her medications, or even gone back on them sooner, it’s possible she would have survived.”

In the last two decades, postpartum depression has become increasingly recognized, and many states have established programs for screening and treatment. However, antenatal depression, the form of depression Mary was experiencing, is a far less recognized issue, despite the fact that this form of depression affects up to 15 percent of expectant women.

Much of the lack of attention regarding maternal depression is due to societal stigma. Many of the misconceptions surrounding these mental illnesses focus on questioning how pregnant women can possibly fail to be joyful. How can pregnant women be sad when they are about to bring a child into the world? Pregnant women are often portrayed to be extremely optimistic, disregarding the physical discomfort they are in because of the fact that they are nurturing a new life.

As a society, we have not done enough to acknowledge the anxiety-ridden aspects of pregnancy. We have not addressed the trauma that can also be associated with all of the change that comes with motherhood. This, combined with the notion that taking antidepressants while pregnant is selfish due to the potential harm to the fetus, often deter pregnant women from seeking help. Wendy Isnardi, who struggled with severe depression during and after her pregnancy, described her battle with the illness: “I thought people who took medication were nuts, until I began to feel like I was really going crazy,” she said. “I had constant thoughts of harm to the baby. I knew that I was not capable of doing the things that were going on in my head, but I needed to make sure that I was not a danger.”

Many women like Wendy and Mary are extremely unsure of how to handle their depression, and this is in large part due to the ambiguity regarding antidepressants and their effects on the fetus. A large number of women, just like Mary, are afraid to go on antidepressants during their pregnancy due to studies that have shown harmful effects on the fetus. However, the reality is that these studies have only come out with preliminary evidence that was not validated properly, and these results have been made into widely universal statistics even though they are not properly supported by evidence.

Because of the possible risks surrounding antidepressants, many women turn to therapy and support groups, such as the ones at the Postpartum Resource Center of New York. However, despite the existence of these support groups, the stigma around depression during pregnancy is stronger than ever, with many women ashamed and afraid to come to these groups in case their husband or families find out. Pregnant women are often not made aware of the wealth of treatment options available to them that don’t involve medication: cognitive behavioral therapy, light therapy, and even electroshock treatment can all reduce depressive symptoms.

In addition to making more women aware of their treatment options, we need to do more research into postpartum and antenatal depression. There is so little known about both of these illnesses. Examining their complexities to better understand the diseases could literally save the lives of both the mother and child.

References:

Belluck, P. (2016, January 26). Short answers to hard questions about postpartum depression. The New York Times. Retrieved from https://www.nytimes.com/interactive/2016/01/26/health/what-is-postpartum-depression-test.html

Belluck, P. (n.d.). ‘Thinking of ways to harm her’: New findings on timing and range of maternal mental illness. The New York Times. Retrieved from https://www.nytimes.com/2014/06/16/health/thinking-of-ways-to-harm-her.html?

Solomon, A. (2015, May 28). The secret sadness of pregnancy with depression. The New York Times. Retrieved from https://www.nytimes.com/2015/05/31/magazine/the-secret-sadness-of-pregnancy-with-depression.html

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Depression

New Avenues for Treatment: Brain Imaging Study Identifies Different Types of Depression

Most of the estimated 16 million adults who live with depression find little relief with antidepressants. This is a problem that most researchers say lies in the way the disease is diagnosed.

In modern-day psychiatry, depression is diagnosed from a list of criteria. If a patient exhibits low mood and four additional symptoms from a list of nine, they are considered to be clinically depressed. However, depression is often not this black and white. Diagnosing depression from a list of nine very different and specific symptoms has led psychiatrists to use the same medication and treatment methods for a disease that manifests very differently from person to person. One individual might be gaining weight and sleeping a lot, while another might be losing weight and feeling anxious much of the time. However, under today’s protocol, both of these individuals would receive the same types of treatment for their depression.

It is this problem that led Conor Liston, a neurobiologist at Weill Cornell Medicine, to study the neurobiology of depression. Liston and his team realized that the current generalized approach to understanding depression has hindered patients from getting treatment that is tailored to their specific needs. In a recent study, Liston and his colleagues set out to find distinguishing characteristics for different types of depression in the form of biological markers.

In Liston’s study, over one thousand fMRI scans of both depressed and non-depressed individuals were analyzed. For each subject, the researchers analyzed 258 brain areas, measuring how strong the connections were within each area of the brain. Researchers found that one brain area, called the subgenual cingulate cortex, has unusually strong connections with other regions of the brain in people who are depressed. This conclusion led Liston and his team to identify four subtypes of depression. The first two subtypes tend to exhibit more fatigue, while the other two subtypes exhibit more restlessness.

This subtyping has implications for both pharmaceutical treatment and different types of therapy. For example, Liston and his colleagues found that individuals that experienced more fatigue with their depression were more likely to benefit from a newer therapy called transcranial magnetic stimulation, or TMS. This method produces small electrical currents in certain areas of the brain, and is usually reserved for individuals who haven’t been responsive to antidepressants. However, because of the identification of different subtypes of depression, Liston and his team are hoping to be able to tell which individuals will not be responsive to antidepressants at all. He is then hoping to develop a method where the physician could scan the patient’s brain through fMRI and target the under-stimulated areas of the brain with more specificity.

This new avenue of treatment and therapy will open up more avenues to treatment than just antidepressants and therapy. Hopefully, more Americans will be able to find treatment that is tailored to their specific depression symptoms, and fewer individuals will continue to suffer in silence.

References:

Drysdale, A. T., Grosenick, L., Downar, J., Dunlop, K., Mansouri, F., Meng, Y., … Liston, C. (2016). Resting-state connectivity biomarkers define neurophysiological subtypes of depression. Nature Medicine, 23(1), 28-38. doi:10.1038/nm.4246

Liston, C., Chen, A. C., Zebley, B. D., Drysdale, A. T., Gordon, R., Leuchter, B., … Dubin, M. J. (2014). Default mode network mechanisms of transcranial magnetic stimulation in depression. Biological Psychiatry, 76(7), 517-526. doi:10.1016/j.biopsych.2014.01.023

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Depression

Depression and Mental Healthcare in Trump’s America

Carol Wachs, a Manhattan psychologist, has recently started seeing an old patient again. The patient had previously come to her in distress over the attacks on the Twin Towers, and was seeking treatment again, years, later, for a new menace: Donald Trump. According to Wachs, the patient sees startling parallels between Trump’s rise to power and the stories she has heard from her grandparents, who are Holocaust survivors.

Wachs’ patient is not alone in her distress. In a national poll of 1000 voting age Americans, 43 percent of the respondents reported experiencing emotional trauma in response to Trump’s campaign and subsequent election. This crisis has only continued to escalate, and recently, therapists banded together to take action. Over 3,000 mental health practitioners signed a manifesto declaring Trump’s tendency for scapegoating, intolerance and blatant sexism a “threat to the well-being of the people [they] care for”. The manifesto states that Trump’s chaotic campaign has brought up feelings of shame, fear, and helplessness among minority groups, who feel alienated and personally targeted by his message.

Although anxiety and fear over a Trump presidency is a normal emotional reaction and not a clinical condition, Trump’s presidency is also contributing to existing feelings of depression in individuals who are already mentally ill. Kimberly Grocher, a psychotherapist in New York, says that Trump-induced distress among her patients is usually combined with other triggers, and can intensify already existing feelings of depression. According to Grocher, for many minority patients, Trump’s proposed policies make them worry about the safety of their communities in upcoming years. For women, the fact that Trump was successful, even with his misogynistic attitude, is extremely disheartening. Many already marginalized groups feel that their rights may be severely limited in the upcoming years, undoing all the progress that has already been made.

With regards to mental health care, Trump has campaigned on the promise to “repeal and replace” the Affordable Care Act, a 2010 law which provides medical coverage including mental health care to an estimated 20 million Americans. Although the Affordable Care Act was in no way perfect, it did provide mentally ill patients with easier access to treatment. In addition, as of now, Trump has been very firm about repealing the law, but has given no concrete plans to replace it. If President Trump is successful in repealing the ACA, he will effectively take away access to treatment from millions of Americans overnight, and the results would be disastrous. Many Americans would be forced to seek treatment in emergency rooms instead of the appropriate facilities. Untreated mental disorders such as depression would most likely lead to higher suicide rates.

America can’t be great if Trump keeps spewing such divisive, alienating rhetoric. We can’t thrive as a nation if so many Americans are living with untreated mental illnesses.  For millions of people struggling to heal not only sick bodies but also shattered minds, the current political climate might trigger a nationwide breakdown.

References:

Friedman, R. A. (2016, December 12). The Mental Health Crisis in Trump’s America. Retrieved from https://www.nytimes.com/2016/12/12/opinion/the-mental-health-crisis-in-trumps-america.html

Goldberg, M. (2016, September 23). Trump-Induced Anxiety Is Real. Therapists and Their Patients Are Struggling to Cope. Retrieved from http://www.slate.com/articles/double_x/doublex/2016/09/trump_induced_anxiety_is_a_real_thing.html

Haberman, M., & Pear, R. (2018, January 20). Trump Tells Congress to Repeal and Replace Health Care Law ‘Very Quickly’. Retrieved from https://www.nytimes.com/2017/01/10/us/repeal-affordable-care-act-Donald-trump.html

Lapowsky, I. (2017, June 03). Obamacare’s Demise Is a Looming Disaster for Mental Health. Retrieved from https://www.wired.com/2017/01/obamacares-demise-looming-disaster-mental-health/

Sheehy, G., Vinograd, S., Moss, B. P., & Glosser, D. S. (2016, October 10). America’s Therapists Are Worried About Trump’s Effect On Your Mental Health. Retrieved from https://www.politico.com/magazine/story/2016/10/donald-trump-2016-therapists-214333

Sun, B. (2017, January 17). Trump’s mystery health care plan. Retrieved from http://www.baltimoresun.com/news/opinion/editorial/bs-ed-trump-Obamacare-20170117-story.html

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Depression

Suffering in Silence

It has been known in the psychological community for years that not all cases of depression are the same. Each individual presents different symptoms, and experiences the illness in their own unique way. However, something that is not often considered with regards to depression treatment and therapy is how cultural factors influence the individual’s ability and desire to get help. Values specific to one’s own cultural identity can heavily influence someone’s view of mental illness, and if an individual lives in a culture where mental illness is not really discussed, they could struggle with obtaining the resources they need. There are varying levels of stigmatization across cultures, with increased levels of stigma being present among minority communities. In particular, South Asian Americans experience higher levels of depression, but use mental health services in extremely low numbers.

“I had everything, but life is a double-edged sword. If I tell everything, I will lose everything.”

This is the note Neil Grover, a medical student at the University of Massachusetts, left before committing suicide in 1998. Neil’s death came as a shock to his South Asian family – they never knew that he was suffering from depression. Over the years, there have been all too many similar cases of suicide among high achieving South Asian youth.

Numerous studies have shown that South Asian women do not seek treatment for mental health unless it has become far too much to bear. South Asian immigrants are additionally less likely to stay consistent with medication after a mental health diagnosis. These outcomes are mostly likely due to cultural factors – South Asian families often cling to strict ideals of perfection, and the presence of a mental illness is viewed as completely shattering this illusion. Oftentimes, having a mental illness is viewed not as something to be treated, but as something that is the fault of the individual.  Additionally, South Asian parents tend to push their children to achieve at extremely high levels, and this is not always conducive to good mental health. In many cases, when children express concerns about not liking their job or their studies, they are told that they just need to work harder. These strict standards coupled with shame, silence and stigma often lead to South Asian youth hiding their own struggles until they are too great to bear.

In a community where failure is equated with giving up, pushing through is often the only option. This is especially true when the community in question is a minority in America and is subject to the social pressure of conforming to model stereotypes. Admitting to flaws within the community would take away the comfortable status that South Asian Americans enjoy within mainstream society. As a result of this, there is an enormous amount of pressure for South Asian immigrants and their children to live up to their own ideals of perfection, and for some, these standards are too high. The tendency of South Asian families to tell their children that others always have it worse than they have is extremely damaging. As a result of this, what is often perceived as a crisis point in mental health is not necessarily treated as one.  

Mental health professionals need to keep this in mind when dealing with patients. As it is, depression is stigmatized enough in normal American society, but it is even more deeply hidden among South Asians. The illusion of perfection is just that – an illusion, and until this is realized as a cultural problem, many South Asians will continue to suffer in silence.

References:

Chew-Graham, C., Bashir, C., Chantler, K., Burman, E., & Batsleer, J. (2002). South Asian women, psychological distress and self harm: lessons for primary care trusts. Health and Social Care in the Community, 10 (5), 339-347.

Ahmad F, Shik A, Vanza R, Cheung AM, George U, Stewart DE. Voices of South Asian Women: immigration and mental health. Women Health. 2005;40:113–30.

University of Missouri Health. (2015, July 23). U.S. South Asians more reluctant to seek medication for pain. ScienceDaily. Retrieved from www.sciencedaily.com/releases/2015/07/150723125609.htm

Tabassum R., Macaskill A., Ahmad I. (2000, September 1). Attitudes Towards Mental Health in an Urban Pakistani Community in the United Kingdom. doi: 10.1177/002076400004600303

Sohrabji, S. (2013, July 12). Suicide Amongst Indian Americans We’re Stressed, Depressed, But Who’s Listening?. India — West. pp. A1-A22.

Categories
Depression

A Window into Depression

Depression, like many mental disorders, varies with each individual. In order to create an effective treatment plan, each person’s situation and condition must be taken into consideration. My grandmother, who wishes to remain anonymous, was formally diagnosed with depression ten years ago. In the following interview, she recounts her own struggles with the disease in the hopes of inspiring others to get help if they need it, despite their circumstances.

Question: Describe your depression.

Response: It’s this heaviness in my head that never goes away… sometimes the pills help, and sometimes they just make me feel worse. It definitely varies from day to day… some days, I can get up and try and help out around the house, and on other days I just want to lie in bed. It never goes away, and I can’t control it, which makes it so much more difficult to deal with.

Q: When did you first realize something was wrong?

I started really struggling when you were little, about ten years ago. I didn’t understand it — I had my own house, beautiful grandchildren, and I had just finished my second master’s degree. I was teaching, and I remember not being able to get out of bed to go to work… I was constantly worried and I didn’t want to face the day. But looking back, I think something might have been wrong long before I started getting help… Back in Guyana, I would stay in my room for hours by myself, not wanting to do anything. My mother had the same types of issues when I was little. I think it runs in the family.

Q: How has your journey to recovery been?

Depression and mental health were never really discussed in my family, you know… When I got diagnosed, I wasn’t entirely sure what depression was. I thought I was just sad, and that I didn’t need medication. Even your grandfather told me that I was just acting crazy….. I thought I was crazy, myself, you know. I kept telling myself to snap out of it… I couldn’t comprehend how there could be something wrong with the chemicals in my brain. I didn’t think that was possible. Recovery was a struggle because I didn’t accept that I was sick for a while. Your mother, your father, and your grandfather all told me that I wasn’t sick… They told me to take walks, to do crosswords, to do something to ‘keep my mind active.’ When none of those things worked, I ended up hospitalized and on medication, and I felt like such a burden to the family… I only started feeling better when I accepted that I was ill and started seeking treatment instead of refusing it.

Q: What advice can you give to others?

When you have depression, you can’t just snap out of it… You need people that care for you that want to help you… Make sure you surround yourself with support. You can’t go through depression alone.

Oftentimes, people suffering from mental illnesses feel isolated. Reading other people’s stories can help to humanize the illness, and can provide a welcome counterbalance to statistics from medical journals or diagnoses from psychiatrists. Sometimes, just relating to the story of another human being creates a sense of connection and stability more profound than any medication or therapy can offer.

Categories
Depression

The DSM and Depression: Flawed Labeling Leads to Misdiagnoses and Increased Stigma

The DSM has long been hailed as psychiatry’s “bible”; clinicians across the country have used the Diagnostic and Statistical Manual as their guide to identifying mental illness. However, in recent years, the reliability of the DSM has been called into question by psychiatrists and doctors alike. For depression, specifically, the DSM falls short in field tests, with test-retest reliability being extremely questionable. Depression screening and treatment is currently based on an extremely flawed set of standards, and this is providing a basis for misdiagnoses and false positives (Nemeroff et. al., 2013). Furthermore, although the compartmentalization of mental illnesses into specific categories may be necessary for treatment, strict categorization is contributing to an increased number of diagnoses per patient, which is creating labels and causing negative stigma (Szalavitz, 2013).

The DSM V lists nine criterion for depression, and goes on to put these symptoms under one of two categories: 1) depressed mood and 2) loss of interest or pleasure. It states that five (5) of these nine criterion must be met in order for a patient to have depression. The manual goes on to list 4 more categories that specify conditions that must be met in order to make sure the patient has depression (APA, 2013). There are two main issues with this approach. Firstly, the symptoms proposed by the DSM vary widely, but the treatment options for varying degrees of depression are very similar. This can be highly detrimental to the patient because the treatment is not specialized enough (Szalavitz, 2013).  Additionally, a lot of the symptoms for depression can be indicators for symptoms of other mental illnesses such as anxiety. This leads to false positives and diagnostic inflation, which is when a patient is over diagnosed with a multitude of mental illnesses, and perceived comorbidity, which is when two chronic illnesses are present simultaneously.

For a lot of patients, diagnostic inflation and false positives can lead to feelings of hopelessness and despair, as in the case of Maia Szalavitz. In her 2013 article for TIME magazine, Szalavitz states that she has been diagnosed with no fewer than six mental illnesses over the course of her lifetime. Szalavitz goes on to say:

My multiple diagnoses are the rule, not the exception, and one criticism of the DSM structure is that if you qualify for one diagnosis, you typically also qualify for others. Which one should be treated? Or do they all require interventions? And what if the therapies conflict with each other? You see the problem” (Szalavitz, 2013).

Although diagnostic labels are sometimes needed for treatment, over diagnosing patients can lead to risky medication combinations and incorrect labeling (Szalavitz, 2013). An increased number of diagnoses can understandably lead to more despair in the patient without providing a concrete solution to the patient’s problems (Batstra et. al., 2012).

Diagnoses are not at all an exact science, and the DSM tries to treat them as such. Overall, not enough is known about mental illnesses such as depression to narrow symptoms down to a precise list of categories. Labels for mental illnesses are far from perfect, and over labeling adds to stigma and only increases patient distress. To some extent, we do need labels, but mental health professionals should realize that these labels are not set in stone.

References:

Special thanks to Dr. Nicholas Eaton for providing information for this article

Batstra, L., & Frances, A. (2012). Holding the Line against Diagnostic Inflation in Psychiatry. Psychotherapy and Psychosomatics, 81(1), 5-10. doi:10.1159/000331565

Hunt, C., Slade, T., & Andrews, G. (2004). Generalized Anxiety Disorder and Major Depressive Disorder comorbidity in the National Survey of Mental Health and Well-Being. Depression and Anxiety, 20(1), 23-31. doi:10.1002/da.20019

Nemeroff, C. B., Weinberger, D., Rutter, M., MacMillan, H. L., Bryant, R. A., Wessely, S., … Lysaker, P. (2013). DSM-5: a collection of psychiatrist views on the changes, controversies, and future directions. BMC Medicine, 11(1). doi:10.1186/1741-7015-11-202

Pearson Clinical. (2013). Major Depressive Disorder. Retrieved from http://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_MajorDepressiveDisorder.pdf

TIME. (2013, May 17). Viewpoint: My Case Shows What’s Right — and Wrong — With Psychiatric Diagnoses. TIME Magazine.