Category: mental illness

The mentally ill are more likely to be victims of violence – not perpetrators

One of the common misconceptions of mental illness is that the mentally ill are a monolithic group of lunatics, running around, committing violent acts.  This is perpetuated in a variety of ways, including popular culture and the media, who tend to highlight and sensationalize the unfortunate incidents when someone when is mentally ill commits an act of terrible violence.

Of course, that isn’t the case at all.

Let me address this stigma in two parts.  First, as has long since been established, mental illness, like most physical disorders, exists over a spectrum.  Nearly 1 in 5 American adults has some form of mental illness.  Breaking that down further, however, reveals a far more nuanced picture.

First of all, I vehemently object to the idea that “mental illness” is a big block.  It comes in a variety of symptoms, severity and specific diseases.  As noted above, nearly 1 in 5 American adults have some sort of diagnosable mental illness over the course of a year.  Roughly the same number of 13-18 year olds fall into the same category.  Over the same time period, 1 in 25 adults suffers from a mental illness that is severe enough to qualify as a “functional impairment.”  At the same time, roughly 100,000 people, per year, have their first episode of psychosis.

So, first and foremost, let’s dispatch the idea that all mental illnesses are the same.  They  vary in a variety of respects.

Second, it’s important to keep this in mind: Being mentally ill makes someone far more likely to be a victim of crime, not a perpetrator of it.  I get that the popular stereotype of the mentally ill has led people to believe that this isn’t the case, but again, reality is very different than perception, and when you think about it, this makes sense.  Someone who is mentally ill is far more likely to lack complete control over their faculties, health, finances, etc.  As a result, they are vulnerable to society’s criminal elements.

Let’s take a look at the research.  According to a 2014 study by North Carolina State, roughly 24% of the mentally ill who were surveyed (out of 4,480) had committed an act of violence over the past six months – but 31% had been a victim of it.  Breaking it down further, of those who had committed an act of violence, 63.5% had done so in a residential setting, while only 2.6% had done so at school or the workplace.  This doesn’t make the act of violence any less important or tragic, but it does mean that the mentally ill are rarely a danger to the general public.  Unfortunately, it may mean that family members can be.

Taking this research a step further: According to governmental surveys, only 3-5% of violent acts come from someone living with a serious mental illness.  And this, again, makes an important distinction: A serious mental illness is more than just someone who gets periodically anxious.  It is defined as:

a condition that affects “persons aged 18 or older who currently or at any time in the past year have had a diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance use disorders) of sufficient duration to meet diagnostic criteria specified within DSM-IV (APA, 1994) that has resulted in serious functional impairment, which substantially interferes with or limits one or more major life activities”

As a study from Washington notes, this leads to exaggerated views of the connection between mental illness and the general public.  This, in turn, leads to widespread stigma, discrimination, treatment avoidance and a lower quality of life for those who suffer from mental illness.

 

I suppose, ultimately, it comes down to this.  The mentally ill – from a mildly anxious teenager to the most severely schizophrenic homeless senior – deserve to be treated with basic human dignity and respect.  Stigma is so dangerous because it is pervasive, and any broad-based, inaccurate characterization of mental illness dehumanizes those who suffer and forces them to keep their illness in the dark.  Violence among the mentally ill is rare – tragically, becoming a victim of violence is a far more likely scenario.  It is vitally important to the destigmatization movement that we continue to fight back against all inaccurate portrayals of mental illness, including this one.

A shameful disparity: Minorities & Mental Illness

Earlier this week, I had the good fortune to attend Pride in the Park, the Lehigh Valley’s annual LGBT festival.  I always bring the family and it’s a blast; it’s interesting, has great vendors, good food and is a great time for the kids.

On our way out, I commented to my wife that everyone at the event always seemed so happy, and how relaxing it must be to attendees to be in a place where you know no one cares who you are.  My wife corrected me: Everyone cares.  Period.

This reminded me of a tragic reality about mental illness in America: If you are a minority, you are more likely to be mentally ill, and less likely to be treated.

Before I go into the statistics, one caviet: “Minorities” is a broader term than you think.

African-Americans
African-Americans make up 13.2% of the U.S. population, and 16% of those have a diagnosable mental illness.  However, the disparity is striking.  African-Americans are 20% more likely than whites to say they suffer from serious psychological issues.  They also feel worse, in terms of sadness, hopelessness and worthlessness, than whites. Stigma-related attitudes are more likely to be held by African-Americans than whites, and cultural competency amoung mental health providers remain a real issue.  Perhaps most significant: 15.9% of all African-Americans are uninsured, compared to 11.1% of whites.

LGBT Americans
LGBT Americans are three times as likely to suffer from mental health conditions than the rest of the general population.  According to the National Alliance on Mental Illness, much of this is due to “minority stress,” including, “social stigma, discrimination, prejudice, denial of civil and human rights, abuse, harassment, victimization, social exclusion and family rejection.”  Suicide is also a major issue within this community, with suicide for LGBTQ Americans aged 10-24 being described as “one of the leading causes of death.”  LGBTQ individuals are four times as likely to attempt suicide than the general population, and 38-65% of transgender individuals experience suicidal ideation.

Rural Americans
Clearly, rural Americans are different than some of the other groups here.  But, that doesn’t change a central fact: They have similar challenges when it comes to mental health than many other groups.  Rural Americans have roughly the same rate of mental illness as the rest of the population.  However, poverty is higher in many sections of rural American, and stigma presents a huge cultural barrier to seeking care. Additionally, rural Americans have problems with accessing care due to practitioner shortages and transportation issues.

American Indians
This is astonishing: The suicide rate among males, aged 15-24, who are American Indian or Alaskan Native, are 2-3 times greater than the suicide rate for whites.  Additionally, 21% of all Native Americans had a mental illness over the past year, and they experience psychological distress at a rate 1.5 times more than the general population.  High levels of poverty, a rural location, poor transportation and low rates of health insurance (33%!!) all lead to low treatment usage.

There is more, but these were just some of the low lights.

I don’t want to necessary explore this from a policy perspective – at least, in this entry.  I’d rather approach this from the personal perspective.  In this sense, I suppose I am lucky; I’m a white, male, young adult, whose only claim to any sort of minority status is that I am Jewish.  That being said, I cannot imagine how difficult it must be – to be a member of one of these communities and have your ability to get and receive care be compounded by factors beyond your control and things that shouldn’t make a difference anyway.

Now, to ignore what I just said: Speaking a a policymaker, it’s pretty clear that there is no one size fits all approach to ending mental health disparities.  A ton of factors play a part, including access to care, stigma, availability of practitioners, cultural competency, discrimination and more.  Mental illness is a huge problem, and an under discussed one.  I suppose that’s why I’m blogging and lending my name to this effort.

We have to do better.

Is Donald Trump bad for your mental health? And what can you do about it?

 

Alright, let me start by admitting that I really debated writing this one.  I’m a politician, and a pretty progressive/Democratic one at that, so as you can imagine, I am pretty much diametrically opposed to…err, everything Donald Trump stands for.  As a result, the last thing I want to do is to be accused of “bringing politics” into a mental health discussion, something that I legitimately think happens too often.  I’m going to do my best to stick with legitimate, reputable sources as I discuss this issue, and try to approach it from the most objective angle possible.

The short answer to this question is yes, the President of the United States can be damaging your mental health.  That, of course, depends on a variety of factors.

Let’s start in my favorite place, Twitter:

Well, that was stressful.  And yes, there are plenty more.  I will say that, in my personal life, I’ve repeatedly joked that this election turned me from an elected official into a therapist: I can’t tell you how many people I’ve spoken with who are suffering from Trump-related anxiety.

In the immediate aftermath of the election, 24/7 crisis lines found themselves overwhelmed with calls from frightened individuals.  Then there is this Daily Dot article, which led with the subtitle, “If you’re a liberal with a history of depression or trauma, this presidency could be more damaging than you thought.”

Well, crap.

From the perspective of a therapist, there’s no doubt:

Several patients with histories of sexual abuse and self-image concerns told me that they experienced significant increases in anxiety. One reported that the constant news coverage triggered memories of her past sexual abuse, and another suffered frequent crying spells and difficulty sleeping.

Quoting multiple therapists and psychiatrists, the article notes that many clinical professionals have had patients tell them that they are experiencing additional anxiety, worry and depression as a direct impact of Trump’s rise to the Presidency.  This effect is particularly pronounced for members of threatened classes, such as people of color, the LGBT community or other religious minorities, many of whom are already more likely to suffer from mental illness.

Then there is this survey, conducted by the website CareDash.  The data below is copied directly from the survey:

  • More than half (59%) of Americans are at least somewhat anxious because of the November election results. The national survey findings mirror an online poll of CareDash newsletter subscribers which found that 55% of respondents are at least somewhat anxious because of the November election results.
  • Nearly three-fourths (71%) of people 18-44 are at least somewhat anxious because of the November election results.
  • Half (50%) of Americans are looking for ways to cope with the negative political environment.
  • Over one-third (39%) of Americans are avoiding social media to reduce their anxiety around the political comments.

Another survey, conducted by the American Psychological Association, found that 52% of Americans believed the 2016 elections were a very or somewhat significant source of stress in their lives.

It seems pretty clear: Yes, Donald Trump has had a negative effect on the nation’s mental health.

So, all of this begs the question: What can you do if you are suffering from Trump Anxiety?

This Lifehacker article and this article from Psychology Today lay it out pretty nicely: Don’t just worry.  Channel that worry into something real and tangible.

  • Ask yourself some key questions about what you can and cannot do.
  • Get active in politics or other social causes – ones that you care about – that will help you reestablish a sense of control in your life.
  • Stop reading the news all the time.  There is a difference between being informed and being obsessed.
  • Connect with others; family, friends and people who, like you, are under serious stress.
  • Exercise!
  • Write down your anxiety.  Don’t just let it be free-floating – write what is troubling you, and use the information you gain from that writing to fight back.

The elections, and the aftermath, have been extremely stressful to some.  If you are one of those people, know you aren’t alone.  If you aren’t, I hope this entry gave you some perspective: There are real people who are truly suffering as a direct result of the election and its aftermath.

As always, I’d love your thoughts in the comments below!

An overview & critique: Depression in fiction books

For reasons that I will inevitably wind up discussing more in-depth later, this is a topic that I am very interested in.  After all, there is no doubt about it: So much of our world is informed by our media, including fiction books.  Major pop culture phenomenons – books like Harry Potter and The Hunger Games, for instance – wind up having a major impact on a whole slew of societal attitudes, everything from the names of our children to the hobbies we play.

Of course this extends to serious issues, like mental health.  As I sat, thinking about this entry, I came to the realization that I cannot think of too many books I’ve read that explicitly feature stories about characters who feature mental illness – even when the book is potentially about something other than mental illness.  This is important from a stigma perspective: I think it is vital that readers hear stories about people with mental illness living a successful life, despite their challenges.

Now, please don’t misunderstand: Just because I haven’t read them doesn’t mean they aren’t out there.  A very quick Google search reveals no shortage of books that discuss exactly this topic.  And, indeed, many of these books touch of mental illness in a more tangential way.

Two young adult books that I’ve read immediately come to mind.  One is Fangirl by Rainbow Rowell, which discusses a young woman moving to college and dealing with a slew of pressures, then finding therapy in her writing.  Another, Anthem of a Reluctant Prophet by Joanne Proulx, features a character who clearly is struggling with depression and anxiety, even though it goes unspoken throughout the novel.

I’m coming at this from the perspective of Young Adult novels, which I must confess, I still enjoy (a quick look at my Goodreads page will confirm this!).  But, from the perspective of mental illness, there is an important reason for discussing this genre in particular: 50% of all mental illness starts at age 14, and 75% by age 24.  If this issue can be addressed early enough – particularly during it’s onset – it can make a big difference.

I suppose my point is this: As best I can tell – and, again, admittedly, I could be wrong, please correct me if I am – it seems like mental illness in fiction is addressed in one of two ways:

  1. It is completely undiagnosed, leaving readers guessing or playing armchair psychiatrists, and that’s never a good idea.
  2. It is the centerpiece of the book.

Don’t get me wrong, neither of these things are necessarily bad in and of themselves.  I’m just having this conversation from a stigma perspective.  The first option listed above can be problematic and fail to fully address a characters illness, which can lead to misguided perceptions about the way that mental illness works.  The second option can be good, but it, too, can make people think that mental illness is somehow more debilitating than it truly is.

Also, please understand, I’m not criticizing any author or book.  Many of the ones that deal with mental illness – directly or indirectly – are powerful, and it’s not possible or fair to be critical of an author simply because they don’t address a particular issue in a way I want to see it done.

That being said, from a stigma perspective, that’s what I’d love to see more of.

Any thoughts to add, or books I am missing?  I’d really love to know – if only to read them!  Please let us know in the comments.

Depression is more than feeling sad

One of the things I have certainly struggled with in my personal life – and I think one of the things that many people don’t realize – is what depression truly is.  I saw this image ages ago in my Facebook feed, and I think it sums it up personally:

depression is more than sad

This is so, so accurate (except for the Mario Kart part – I got nothing there) and I say this based on more than just a viral image.  According to the DSM (Diagnosis & Statistical Manual, the official way in which mental illnesses are diagnosed), the following five symptoms are indicative of a Major Depressive Disorder:

  • Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feeling sad, blue, “down in the dumps,” or empty) or observation made by others (e.g., appears tearful or about to cry). (In children and adolescents, this may present as an irritable or cranky, rather than sad, mood.)
  • Markedly diminished interest or pleasure in all, or almost all, activities every day, such as no interest in hobbies, sports, or other things the person used to enjoy doing.
  • Significant weight loss when not dieting or weight gain (e.g., a change of more than 5 percent of body weight in a month), or decrease or increase in appetite nearly every day.
  • Insomnia (inability to get to sleep or difficulty staying asleep) or hypersomnia (sleeping too much) nearly every day
  • Psychomotor agitation (e.g., restlessness, inability to sit still, pacing, pulling at clothes or clothes) or retardation (e.g., slowed speech, movements, quiet talking) nearly every day
  • Fatigue, tiredness, or loss of energy nearly every day (e.g., even the smallest tasks, like dressing or washing, seem difficult to do and take longer than usual).
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day (e.g., ruminating over minor past failings).
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day (e.g. appears easily distracted, complains of memory difficulties).
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideas without a specific plan, or a suicide attempt or a specific plan for committing suicide

The first item is specifically about depression and feeling sad.  The rest are most definitely not.  And it’s important to note that everyone experiences depression differently, and at different times.  For some, sadness is the overwhelming emotion.  For others, it’s complete anhedonia.  These emotions are felt in different ways, at different times.

I write about this based on my own experiences.  I’ve found that, when I am going through a rough patch, it isn’t often led off by sadness – usually, I start with insomnia and a loss of appetite – I always lose weight when I am depressed.  Things usually go downhill from there.  Not for nothing, but those two symptoms are often the canaries in the coal mine.  I work out a lot so I’m almost always hungry, and if I don’t want to eat, I almost always wonder if something is wrong.  It’s amazing, the way depression sneaks up on you like that…it comes out of nowhere and starts to nibble at your mind, before you are even aware of it….

My point is this: It would be foolish to assume that depression is just depression.  It can be experienced as an entire series of symptoms, many of which have nothing to do with feeling sad, and all of which can easily be confused with something else.  I draw some comfort from this – there is nothing “wrong” with me – well, besides the obvious, haha.

I’m really curious to hear from others.  Have you experienced depression in some other way, including those not listed here?  Let us know in the comments!

You are not alone: A quick – and personal – review of depression statistics

On my drive home today, I was listening to a podcast called Everybody’s Fucked Up, a podcast by two video game developers who have both struggled with mental illness.  One of them, Tessa Vanderhart, discussed how one of the best things she discovered in therapy was that it helped teach her that no one who suffers from mental illness is truly alone.

That reminded me of a story from when I first got to college, and when my own depression really exploded.  It was the 2nd or 3rd day of school, and I am completely freaking out.  I still remember everything about it: It was a gorgeous, late August day.  I was sitting on the steps just outside of my dorm, on my oversized cell phone, talking with my Dad.  A group of girls walked by, and they were laughing and smiling.  I knew one of them from high school, and she waved at me.  I sheepishly waved back – my face was obviously tear-stained.  I had been balling, homesick, can’t adjust, I am convinced I had no friends, it’s never gonna get any easier, I want to go home, all that good stuff.  Anyway, I’m on the phone with my Dad, telling him how I was sure I was the only one who felt this miserable, because, after all, I didn’t see anyone else who was as upset as me. Exasperated, he responded, “Of course you don’t!  That’s because they are all in their rooms, crying like you!”

He was right, of course. I later found out that .5% of the kids in my class actually dropped out the first weekend because they just couldn’t handle being away from home, and that says nothing of the kids who were just struggling like me.  But, that story actually illuminated a bias that I’ve found still remains when it comes to mental illness: Far too many people think that they are truly the only ones suffering, because they don’t see anyone else.

Nothing, of course, could be further from the truth.

I want to give you two statistics on mental illness and try to personalize them as much as possible.  A quick look at the literature shows:

  • 43.8 million American adults – about 18.5% – experience mental illness at some point in a year.  So, dear reader, let’s assume for a moment that you are one of the unlucky 18.5% of Americans who suffer from mental illness, and you think you are the only one.  Okay.  Let’s say you are sitting in class, and say there are 25 people in that class.  Odds are pretty good that you and four others have mental illness.
  • 18.1% of Americans will experience some sort of anxiety-related disorder over their lifetimes.  You work in an office of 50 people, and you are in the bathroom,  heart accelerating, stomach churning and bawling your eyes out, but trying to do so quietly so no one wonders what is wrong.  You think you are the only one?  Odds are that nine other people are in a different bathroom, panicking for no reason or reliving some highly traumatic event.

One of the bad things that researchers and politicians have a tendency to do is to talk in the abstract, to talk in big, global numbers, and not give those numbers any context.  Sure, 43.8 million Americans sounds like a lot, right?  What makes even more of an impact is a personal one – a friend, a colleague, a classmate, a coworker.  This is even more important for people who suffer from mental illness – we are more than just a number, and it’s important that we be seen as such.

When you think of mental illness, or when you think of your own mental illness, one of the hardest things to remember, sometimes, is that you aren’t alone. As you sit in your bed crying, or at your desk, wondering how you are going to get through the day, or scrolling through your Facebook newsfeed in a desperate effort to take away your pain, you have to try to remember that you aren’t the one suffering.  There are millions upon millions of you – of us – that share your pain at any given moment.

Try to remember that, and try to let that thought give you some comfort – you aren’t the only one.

Video games and depression

One way I cope with depression is video games, which some studies have noted can help improve social anxiety, depression and stress levels.  I wanted to elaborate on this one a bit.

First: I love video games.  And I mean I loooooove video games.  I can tie most major periods of my life to some sort of video game.  I still remember playing Halo 3 on Xbox live before I went out on my first date with my wife (the guys I was playing with wished me luck when I said why I was leaving for the night).  I remember Final Fantasy X before college graduation.  Skyrim when my son was first born, too little to move and would curl up on my chest while I slayed dragons.  My kids are named Auron and Ayla…bonus points if you can figure out what games those names came from.

I still remember being almost five, coming home from Heather Cohen’s birthday party, and my Dad leading me into our basement, where he gave me the most magical birthday present every: A Nintendo Entertainment System.

Video games have a special place in my heart.  As I grew older and began my journey with depression and anxiety, they offered a safe place and a retreat from reality.  I can see myself playing Grand Theft Auto 3 when I was going through a rough patch with my girlfriend at the time.  During the worst of my anxiety in college, again, it was Final Fantasy X. I still remember being a lonely, awkward middle schooler and just being obsessed with Tie Fighter, because it made me feel good at something.  In the Star Wars universe, no one cared that your hair wasn’t stylish, or that your forehead resembled a pepperoni pizza more than any normal persons should.  You just shot at the bad guys.  End of story.

That being said – that concept of escaping into a video game – is it a good thing?

Personally, I’ve had some experience with MMORPGs, but not a ton.  As much as I love video games, I don’t have enough time to truly enjoy them.  I’ve played my share of them – Warcraft in particular – but, as a newcomer, always found them to be too intimidating to really get into.  However, there’s no question about it – some people get into video games at the expense of real life.

On one hand, there is research with shows that video games can be helpful in reducing stress, anxiety and depressive symptoms.  They provide a creative outlet and a safe place to retreat to when the real world can get overwhelming.  Of course, that retreat can be toxic, which leads to the concept of video game addiction.

Now, to be clear, though there is no shortage of media reports about video game addiction, it is not yet an officially recognized disorder by any major medical governing body.  On an anecdotal level, I suspect that many of us know people who are way, way too into fantasy worlds, but that doesn’t mean they are “addicted,” per se.

I also think it’s worth noting that video games have never been an area free of controversy, and the conversation about whether or not games are addictive have been going on since Space Invaders.  So, clearly, this is a conversation that has gone on for quite sometime.

Are video games good or bad for mental health?
Like the answers to most perplexing questions, this one is evolving.  Video games have positive benefits on depression and anxiety, as far as I am concerned.  I’ve found them to be a safe retreat and a chance to temporarily escape the pressures of the real world.  In my opinion…again, just my opinion, not any medical advice…they can be great, but no different than any other hobby.  You use them briefly to recharge and recalibrate before launching yourself back into the real world.  The challenge, of course, is acknowledging when enough is enough.  For some people, that can be more difficult than others.