Post Traumatic Growth

In the course of discussing mental illness, I’ve written quite a bit about PTSD and its devastating impacts. If you have had the misfortune of experiencing some sort of traumatic event, you don’t need me to tell you just how much this can negatively impact your life, because you live it every day. PTSD isn’t a small problem: According to available statistics, 1 in 13 people will develop PTSD at some point in their lives.

However, I don’t want to talk about PTSD today. I want to talk about a different concept: Post Traumatic Growth.

I’ve been thinking a lot about this one of late – mainly because I want to know what circumstances make it possible. PTSD, or Post Traumatic Stress Disorder, is the concept of showing positive growth or change after a devastating event. It is basically the idea that you can turn a negative into an incredible positive and come out stronger in the aftermath of suffering.

According to this article from the American Psychological Association, PTG is different than resilience, which is the factor that determines if you can recovery from a traumatic event. One inventory holds that these five factors determine if you experience PTG:

  • Appreciation of life.
  • Relationships with others.
  • New possibilities in life.
  • Personal strength.
  • Spiritual change.

How we measure PTG isn’t as important to me as determining how to encourage someone to experience it, and I think this is an important question for people who suffer a traumatic event – how can they not only get through it, but grow from it?

According to the article, some people are predisposed to experience PTG. There are also a variety of other factors, including the type of trauma, the circumstances and the age of the individual in question (being 8 or younger decreases the chances of PTG). Furthermore, people who are more open to new experiences and extroverted are more likely to experience PTG. One study also found that there may be genetic connections to PTG, with individuals who had certain variations of the gene RGS2 being found as more likely to experience PTG.

As I’ve said repeatedly, I’m no doctor or therapist – I just play one on this blog. However, being able to show post traumatic growth strikes me as an incredibly difficult thing, one which requires a ton of support and therapy to prove. I would think that there is a real connection to optimism and resilience – to the notion that you can find light in the darkness. For many, a traumatic event – such as an assault or accident – proves to be too much to ever recover from.

However, I’d also hope that knowing that PTG is possible – indeed, achievable – can give people a new appreciation on life, on trauma, and even on depression. I mean, look at the article above, or just search for the subject. The internet is replete with examples of people finding light in the darkness, of using a traumatic experience to grow and change and become better people. Knowing that this is out there – that there are people who’s lives have been made better by trauma – that should inspire hope in all of us who are suffering.

Folks, I’m grateful for my depression and anxiety. It gave my career purpose and meaning and allowed me to use my experiences to make the world a better place. And, I suppose, that’s the best way I can look at what otherwise could have been a crippling illness.

Any thoughts on the concept of PTG that you want to share with us? As always, leave them below!

The Best Way To Help Veterans With Mental Illness

Today is Veterans Day, the day of the year in which we are supposed to remind ourselves about the importance of the veterans who have served all of us. It’s a solemn day…one which most people know better by the kind of sales they can get and if they get the day off or not.

As an elected official, I’ve certainly been to my share of Veterans Day events, and had three leading up to today. That being said, they are events which always leave me feeling inadequate. Why? I never served in the military, and while I don’t believe that is necessary to be a good public servant, I do always worry about talking to veterans and thinking that they must think I don’t understand what they have been through. That’s me projecting, to an extent, but of course, I don’t understand what they have been through, the things they have seen.

As a politician, I’ve always said that I want to be judged by my actions, not my words. And when it comes to taking care of our veterans, far too many of our actions come up short. This goes double when it comes to mental illness. A brief look at the facts reveals:

These numbers are unacceptable. Those who give so much for us should receive even more in return. That being said, for the vast majority of us, our options are limited. Let me pose this question, then, if you’d like to learn more about how to help our vets: What can you do to help veterans who are suffering from a mental illness?

Here are a few thoughts.

Understand what you don’t understand

One of the things I have realized in my time in government and the mental health universe is that you will not understand everything – and that’s okay. You don’t have to understand what it was like to serve. You don’t have to actually have experienced someone else’s pain to understand that it exists. Not being a veteran doesn’t disqualify you from this conversation, but it does require extra effort. Read up on the specific challenges which veterans face. Learn more about what they need and how you can help. This broader prospective will put you in a better position to help those who need it.

Support groups who support vets

While the need is great, the response has been as well. Numerous organizations do a fantastic job of taking care of our veterans. If you can afford to do so, please contribute to these organizations, because while the passion is there, the funding often is not.

Read up on veteran-specific mental health issues

Part of understanding veterans issues is learning more about them. PTSD and TBI (traumatic brain injury) are both tragically common for veterans. If this is something you want to learn more about, read up on these two devastating diseases, and learn more about how you can help.

Talk about it, and find others who know more

The best way to address and reduce stigma is to talk about it – but to do so in a way which is inclusive. Discussing mental illness is important, but talking about it from the perspective of a veteran even more so. Make sure to be inclusive when discussing mental illness and stigma, and make sure to rely on other voices (like veterans) who may have more experience than you.

I know I missed a lot here – as usual, I’d love your thoughts. Do I have a goo handle on this? What am I missing? Fill us in in in the comments section!

Stigma, Shame & First Responders

My mental health and legislative worlds frequently come together, but an article and what happened yesterday really made me blink.

First, the good news. At a hearing yesterday, the Pennsylvania House Veterans Affairs & Emergency Preparedness committee moved a bill of mine. HB1459 would give first responders more mental health resources. It would require trauma and mental health training, create a peer to peer mentorship program and mandate the creation of a toll-free hotline for first responders who are struggling with mental health issues.

I feel like legislation like this is more important then ever. Why? Stories like this, which report on the NYPD’s ongoing mental health and suicide crisis, and the unwillingness of some police officers to seek mental health help, despite the fact that they feel the need to do so:

In a new report, the Department of Investigation’s Office of the Inspector General surveyed officers who retired in 2016 and found that 25 percent of them reported going through a period of emotional stress, trauma or substance abuse that caused them to consider getting professional help.

But more than a third of those officers did not end up seeking assistance, according to the report.

Half of them expressed fear that the department would find out about their decision to seek support.

So, what do we do here?

First, there are internal things that I think the NYPD can do. Chief among them? Work to change the culture and attack stigma by sharing stories of successful police officers who have experienced mental illness, sought help, and thrived.

Furthermore, the NYPD must do whatever it can to stress the confidential nature of their programs. According to the report, 50% of people surveyed were worried about the department finding out about their illnesses, 45% of negative labels, and 39% afraid of being put on a modified assignment. As the NYPD notes, an “extremely small number” of officers do wind up having their weapons taken away, but they are given those back upon successful treatment. Treatment is confidential, except in cases where the officer in question may present a danger to themselves or others.

The second is broader: We need cultural change at a society wide level. When we discuss the importance of stigma when it comes to mental health, this is why. Stigma is more than just how people look at the mental ill, its how we look at mental illness within ourselves. Clearly, as cases like this demonstrate, a culture of machismo and an overabundance of self-reliance can kill. For reasons like this, we clearly must do a better job of reminding people that there is no shame in seeking help, and that in many cases, its the only way to lead a happy, healthy and productive life.

How mass shootings affect (everyone else’s) mental health

It’s Sunday morning as I type this, the day after a bloody day in America. Unless you live under a rock, you know why.

20 dead in El Paso, Texas.

9 dead in Dayton, Ohio.

The elected official in me – indeed, the human – is outraged. 29 dead YESTERDAY ALONE in mass shootings because America refuses, collectively, to take the policy steps necessary to deal with these tragedies. To act on responsible violence-protection measures which could stop this bloodshed. To condemn white supremacy as a society and rid ourselves of it, root and branch. To adequately fund mental health initiatives which could save lives.

Our cowardice will condemn us all.

Alright. That’s not even the rage-fueled reason I’m writing today, although Lord knows that I could go on for hours about it, and that people much smarter and eloquent than me can and are doing the same. The reason I’m writing today was inspired by this tweet:

Two thoughts: First, this is beyond awful. Second, yes. How many of us have had similar thoughts? You’re just at the mall with family and friends, having a grand old time, and suddenly brought out of your pleasant state by wondering, “Hey, if there’s a shooting, what do I do?”

These thoughts are disturbing, intrusive, unpleasant, and slightly necessary. While the odds of any of us actual being involved in a mass shooting remain low (despite the rise in recent years), the possibility always exists, and it makes sense for all of us to be prepared and aware of the potential danger.

But society has now evolved to the point where, to an extent, we are all wondering about mass shootings. Every time I drop my kids off at school, I wonder about it. It’s in the back of my head, and depending on world events or my mood, it may be front and center. How many of you feel the same?

I would never claim that the pain of any of us not involved in a shooting like this is anywhere near the trauma of someone who was directly involved, so please don’t misunderstand. But, the elected official in me wants to make sure that we are clear about the damage that guns are doing to ALL OF US in society, and that they have changed the way we live in America to a constant state of fear and, as the tweet above puts it, a “low level anxiety.”

I can think of at least two broad and real examples. First, to those of us who are already prone to anxiety/stress and already likely thinking the worst, it gets your guard upon a near constant, low-level basis. It gives you a very real fear to focus on, and that, in turn, can pull you out of a sense of joy or relaxation you are feeling.

Second, and I’d say more damaging, is the impact these mass shootings has on kids. I was speaking with a group of guidance counselors a few weeks ago, and they were telling me how many students they speak with – on a regular basis – who are terrified that they will become a victim of a mass shooting. Again, as bad as things are in America, the odds of that happening are still low. However, the rise in shootings, the nature of our interconnected world and the ubiquity of technology magnify the odds of this occurring. This is particularly true for children or teenagers who don’t have the skills to know that the odds of this happening are still relatively slim. As a result, kids are scared to go to public, safe places – and this includes schools. What kind of damage will this have on them as they grow? As they attempt to learn or find safety and comfort?

We don’t have to live this way. And if we’re ever going to find the courage to actually not live this way, we have to acknowledge the impacts which gun violence has on every member of society, beyond those who are directly effected. The touches everyone of us.

 

Veterans and Mental Health: A challenge which must be met

If you are one of my American readers, a very happy Memorial Day to you, and I hope you get to enjoy this three day weekend with your friends and family.

That being said, my hope with this blog has always been to educate, and I wanted to take a minute to do just that when it comes to Memorial Day. This day, which began to be observed after the Civil War, was done to honor veterans who have fallen in the service of the United States. I’ve always believed that the best way to celebrate this day is not just to memorialize the dead, but to do everything we can to prevent the living from joining their ranks.

As such, let’s take a quick look at the mental health challenges our veterans face.

The numbers, as you can expect, are brutal:

  • According to Mental Health First Aid, 30% of active duty personnel deployed to Iraq or Afghanistan need mental health treatment. However, of that 30%, only half actually get the treatment they need.
  • Post Traumatic Stress Disorder (PTSD) rates are fifteen times higher among veterans than civilians.
  • The depression rate is five times higher among veterans.

Tragically, suicide rates among veterans are also extremely elevated. According to a 2018 report:

  • From 2005-2016, there are roughly 6,000 veteran suicides every year.
  • That number has increased at a rate greater than the rate among the civilian population.
  • The rate of firearm suicides is higher among veterans (65.4%) than non veterans (48.4%).
  • Veterans who used Veterans Health Administration care saw a smaller increase in suicide rates (13.7%) than those who did not (26%).

These numbers are truly brutal. More to the point, they’re shameful. We need to honor veterans with more than gauzy words and the Pledge of Allegiance. These brave men and women truly do put their lives on hold in order to protect the rest of us left behind. They sacrifice. They deserve more than our respect and a day where we barbecue. They deserve our care.

What does that involve? As you can imagine, that answer is complicated, complex and expensive – and well above my pay grade. Broadly speaking, however, I’d argue there are at least a few things we need to do.

First of all, if you have a depressed veteran in your family, it’s important that you know that resources are out there to help. It’s also worth noting that the Veterans Administration is clearly trying to address this continuing problem. There has been extensive talk about overhauling the way we provide our veterans health care, and it’s clear that we need to do more in order to tackle this issue. Furthermore, multiple studies have shown that mental health stigma keeps service members from getting the help they need and deserve. As such, clear that the military, and society as a whole, must continue to tackle mental health stigma.

So, again, happy and solemn Memorial Day to you and your family. I hope that this blog entry has made you more aware of the challenges our veterans face and the unacceptable reality that we lose over 6,000 every year to suicide, and thousands more who suffer from pain-filled lives as a result of their service.

We need to do better. Our men and women in uniform deserve nothing more.

The Parkland tragedy continues, as two survivors kill themselves

Originally, this entry focused on Sydney Aiello’s tragic suicide. I finished it early Sunday morning. And by Sunday afternoon, came to the tragic realization that it needed to be updated.

First: Parkland survivor Sydney Aiello died by suicide last week. The young teenager had survived the massacre at Stoneman Douglass High School, which claimed 17 lives.

According to Sydney’s mother, Sydney “struggled with survivor’s guilt and was diagnosed with post-traumatic stress disorder in the year following the tragedy. And while she reportedly never asked for help, she struggled to attend college classes because she was scared of being in a classroom.”

Like all Stoneman students, Sydney was affected by the tragedy. Like far too many, she lost a friend:

Sydney Aiello & Meadow Pollack

Sydney lost her “longtime friend,” Meadow Pollack, in the shooting.

Next: The second victim. On Sunday afternoon, news broke that a second Parkland survivor had killed themselves. It was a sophomore male, and he, like Sydney, shot himself. As I type this entry, much is unknown about this student, including his name. Unfortunately, the notion of a suicide contagion effect is very, very real – and it is highly possible that this is what we are witnessing here.

The ugly truth is that a trauma never ends when the bullets stop firing. There are always long-term after effects. According to a 2018 survey:

  • Nearly 22% of people who had been raped had also attempted suicide at some point in their life.

  • Approximately 23% of people who had experienced a physical assault had also attempted suicide at some point in their life.

  • These rates of suicide attempts increased considerably among people who had experienced multiple incidents of sexual (42.9%) or physical assault (73.5%). They also found that a history of sexual molestation, physical abuse as a child, and neglect as a child were associated with high rates of suicide attempts (17.4% to 23.9%)

  • People with a diagnosis of PTSD are also at greater risk to attempt suicide. Among people who have had a diagnosis of PTSD at some point in their lifetime, approximately 27% have also attempted suicide.

There is no easy, glib solutions here, but there are ways to mitigate suicide risk after a traumatic event. The American Psychiatric Association lists a few helpful ways to deal with a traumatic event, including:

  1. Keeping informed but avoiding over-saturation with an event.
  2. Learning about local resources and sharing that information.
  3. Remembering that you are not alone and talking with family and friends about your experiences.
  4. Remembering that anxiety and depression after an event are normal, and seeking help if this continue or if you become overwhelmed.

There is, as always, a relatively standard thread here: If you endure a traumatic event, seek help. You are not alone, you are not weak or foolish, and you didn’t deserve whatever happened to you. Therapy – or even just talking to someone – can make a powerful difference.

I have a tendency with these blog entries to take smaller events and turn them into larger points. That’s a conscious decision informed by my experience with mental illness. But I want to conclude this entry by making sure we don’t lose sight of Sydney Aiello or the second student, name currently unknown.

It goes without saying: Sydney and others affected by Parkland didn’t deserve what happened to them. It’s a human tragedy. But Sydney and her classmates spent much of their time after the shooting advocating for a better world. I hope that some good comes of this tragedy, and I hope it is done, at least in part, in memory of Sydney, this second student, and all those affected by this tragedy.

A mental health hero: Jason Kander

Last week, a brave politician made national news by dropping out of a high profile Mayoral race. That man is Jason Kander, and he’s someone worthy of our attention and praise.

Kander is the former Missouri Secretary of State. In 2016, he ran for the U.S. Senate as a Democrat, and in a tough year for Democrats, he came within three points of defeating incumbent Senator Roy Blunt. Kander ran an amazing campaign and aired one of the best ads of 2016, in which he talked about his army background and support for universal background checks while assembling a gun…blindfolded.

Kander’s military story is equally impressive: He volunteered for the Missouri and volunteered for a tour in Afghanistan in 2005, serving as an intellegence officer.

Kander’s political star was on the rise, and until last week, Kander was a candidate for Mayor in Kansas City. That changed with this heartbreaking note, in which Kander discussed his battle with depression, PTSD and suicidal ideation:

About four months ago, I contacted the VA to get help. It had been about 11 years since I left Afghanistan as an Army Intelligence Officer, and my tour over there still impacted me every day. So many men and women who served our country did so much more than me and were in so much more danger than I was on my four-month tour. I can’t have PTSD, I told myself, because I didn’t earn it.

But, on some level, I knew something was deeply wrong, and that it hadn’t felt that way before my deployment. After 11 years of this, I finally took a step toward dealing with it, but I didn’t step far enough.

I went online and filled out the VA forms, but I left boxes unchecked — too scared to acknowledge my true symptoms. I knew I needed help and yet I still stopped short. I was afraid of the stigma. I was thinking about what it could mean for my political future if someone found out.

Kander dropped out of the race and has since been silent on social media. I assume – and sincerely hope – he is getting the care he needs and deserves.

Broadly speaking, the stats on veterans, mental health and suicide are horrifying:

  • According to a 2014 report by the Department of Defense, there were 1,080 suicide attempts (245 suicides) among active-duty service members for all armed services in calendar year 2013.

  • A recent study of 52,780 active-duty members of the U.S. Air Force found that 3 percent of male participants and 5.2 percent of female participants reported suicidal ideation in the previous year. Of the participants that reported suicidal ideation, 8.7 percent also reported a recent suicide attempt.

  • Veterans who screened positive for PTSD were 4 times more likely to report suicidal ideation than veterans who did not, and the likelihood of suicidalideation was 5.7 times greater in veterans who screened positive for PTSD and two or more comorbid disorders.

Those who take care of us – our first responders and military veterans – deserve better. And I sincerely hope that Kander’s story helps to push this issue.

It takes people like Kander – national political rock stars – discuss their pain, to destigmatize an issue, and to help more people get help. I can only imagine how many veterans are looking at Kander and thinking, “Me, too,” and then hopefully getting the help they need. Kander’s words will have a larger impact than I think most of us could ever hope to have.

Most importantly, best wishes to Kander. I cannot imagine what demons he faces – what pain he took on – in the name of protecting America. He, and countless other veterans and first responders – deserve our love, and our resources, to heal. I am so grateful to all of them for their bravery.

Six Questions: Interview with Paula Stokes, author of Girl Against The Universe

Good morning, everyone! Another Six Questions entry for you, and I think this one is particularly interesting. The book is questions is Girl Against The Universe, and the author is Paula Stokes.
From the summary:
From the author of The Art of Lainey and Liars, Inc. comes a fresh, contemporary story about a girl coping with PTSD and the boy who wants to help her move on from the past.  Perfect for fans of Sarah Dessen or Jenny Han.

Sixteen-year-old Maguire knows the universe is against her. No matter how many charms she buys off the internet or good luck rituals she performs each morning, horrible things happen when she’s around. Like that time the roller coaster jumped off its tracks. Or the time her brother, father, and uncle were all killed in a car crash–and Maguire walked away with barely a scratch. Despite what her therapist tells her, Maguire thinks it’s best to hide out in her room, far away from anyone she might accidentally hurt. But then she meets Jordy, an aspiring tennis star who wants to help her break her unlucky streak. Maguire knows that the best thing she can do for him is to stay away, but it turns out staying away may be harder than she thought.

1) Being a psychiatric registered nurse must be the perfect background to write a book like this! Can you talk a bit about how that experience informed your writing?
 
I wasn’t a psych nurse when I wrote this book back in 2014, but I was an RN with a BA in Psychology. I enjoyed incorporating some of the psychological theories that have really resonated with me–like selective attention, self-fulfilling prophecies, systematic desensitization, attribution errors, etc.–into the story. In fact, researching for and writing this novel is part of what made me realize I wanted to go back to nursing but pursue a mental health focus. Having a general background in both psychology and nursing helped me know the right questions to ask, and I reached out to a psychologist and to a couple of friends in therapy for advice on some of the scenes.
 
 
2) What kind of feedback did you get from people who have had similar experiences to your main character, or who have PTSD/anxiety disorders?
 
One of the things I did prior to publication was give the manuscript to three people who had talked openly online about having anxiety and/or PTSD to get their feedback. One of them I did not know at all, but she was a well-known blogger in the YA community who I was following on Twitter and I just saw an opening and went for it. It was scary waiting for their thoughts, but all three of them were really positive and thought the book balanced the reality of mental illness with a hopeful outlook for people who are struggling. They felt I did a good job capturing the somatic symptoms and thought processes of someone with anxiety and PTSD. I have a moderate amount of social anxiety myself, and this book was partially inspired by my own illogical thoughts about how I was responsible for a string of bad events that happened on a solo vacation I took, so I definitely modeled Maguire after myself in places. Obviously my own experiences aren’t going to be the same as other people’s, so the portrayal of anxiety and PTSD didn’t work for everyone, but mental illnesses are not monoliths so that’s to be expected. I’m sorry to anyone who I let down because they didn’t see their struggles represented in this story.
After publication, the reviews were mostly positive and several people sent me messages about how the book spoke to them on a personal level, how it made them want to be more brave or to reach out and ask for help. One big YA blogger reviewed the book and said she wished she’d had it when her mother died, because then maybe she would have gotten the help she needed. It’s incredibly rewarding to send a book off into the world and see it have such a positive impact.
 
 
3) One of the concepts I address in my book is that recovery isn’t an end state, it’s a journey – your writing seemed to mirror that concept. What advice to you give for young adults – heck, anyone, really – who are living that reality and frustrated by it?
 
This is hard for me to answer because everything has always been a journey for me. I grew up in a low-income Midwestern household where my parents were always struggling both personally and professionally. At no point ever would I have described my childhood as stable. Ever since I moved out, my life has been a series of trying on careers and relationships and places to live in a quest for a stability that I still haven’t achieved. I’m over 40 now and it still feels normal to me to be a total work-in-progress, so it’s kind of the same with mental health. The idea that you can just make the right choices and put in X amount of effort and then everything will be fine is a fallacy. I don’t think life works like that for most people. Everyone has stressors and if one of your stressors happens to be mental illness then you’ve got to learn how to minimize how disruptive it will be to your life and accept that you may never be totally *cured* but you can still have a full and rewarding existence. In the book, the therapist, Daniel, says that mental health is fluid and that’s true for everyone. Even people who have never met the diagnostic criteria for a mental illness still have their good days and bad days. So I guess my advice would be that everyone needs to stop trying to be perfect and just be open to who we are and make who we are work for us as much as we can. And therapy! I went to therapy last year because my anxiety was starting to negatively impact my personal and professional life and even just six sessions helped me so much.
 
 
4) Did you design your book to be read by the general public or specifically those that can relate to your main characters struggles? I imagine both, and if that’s the case, how did you straddle that line?
 
The straight answer is that my editor would not have approved the book for publication if she didn’t think it would appeal to a general audience, but I had no idea how the book would be received by people who hadn’t struggled with mental illness or couldn’t relate to Maguire’s magical thinking. I don’t ever think about the “business side of things” when I’m drafting. The story needs to be told the way it needs to be told and if I had the Sales/Marketing team in the back of my brain muttering “But will rich readers from Northeastern cities want to read this? Will librarians in Mississippi buy this for schools?” I would never be able to finish a book.
Once I got done with the initial draft, one of my first beta-readers said she thought the book would really resonate with kids who blamed themselves for their parents’ divorces, which was something I hadn’t even considered. Basically I hoped that even if readers couldn’t relate to Maguire feeling like the Universe was against her, that they’d be able to relate to what it’s like to struggle against negative thoughts that hold us back from being the people we want to be. And if they couldn’t do that, well, the book is still a cute romance with some funny moments and a poignant story about finding your place in a blended family.
In the revision process, I focused on making the abridged therapy sessions thought-provoking for everyone and giving the therapist a personality so those chapters didn’t just feel like me as the author telling readers what to think. I also pulled back on some of Maguire’s obsessive thoughts in places where I felt like being in her head might be getting exhausting or overwhelming for readers who had never struggled with anxiety or PTSD. It’s definitely a tricky balance to represent something like anxiety realistically but also doing so in a way that makes people want to keep reading. I think my best suggestion for writers is to spend time getting to know your characters and understanding them as fully fleshed-out people. Readers will be more likely to root for characters who feel real to them, and they’ll also be more willing to struggle alongside them, even when they can’t relate to what the character is going through.
 
5) What’s your advice to authors who want to write credibly about a subject like PTSD or mental illness, but they don’t have the life experience to necessarily do so?
 
My advice for anyone who wants to write outside their own perspective or experiences is first to reflect really hard about *why* they want to write that particular story. I support the #ownvoices movement, but I also think authors should be able to write any story they need to tell. (And if you’re not sure how I can reconcile those two things, it’s simple–I think publishers need to publish the best stories without imposing any kind of cap or quota based on characters’ cultures, races, disabilities, orientations, etc. If you publish thrillers and you receive five thriller manuscripts with gay, disabled, Chinese protagonists and they are all awesome then publish them all–it’s not like those groups haven’t been underpublished in the past.)
But when it comes to writing outside your experience, I think authors need to have a specific reason for doing so, beyond “oh well I saw this article about a person with X disorder and I realized there aren’t many books about X disorder so it seemed like a cool thing to do.” Mental illnesses aren’t “cool things” to be exploited for profit any more than races or cultures are, so my recommendation would be that unless the writer has a strong personal motivation to tell the story, e.g. “Someone I love has panic disorder and I wrote this book both as a tribute to her and a way to better understand her so I can support her when she’s struggling” that they should steer clear.
In order to write convincingly from outside your experiences, especially when representing a marginalized group, you need to be willing to commit at least an hour of research time for every hour of writing time (which is a lot easier to do if you have a strong personal motivation for telling a story). You need to be brave enough to approach multiple members of the group you’re representing to read your manuscript and you need to be open to hearing their honest feedback. You need to be willing to take responsibility and apologize when you mess up. You need to accept the fact that no matter how hard you try, your portrayal won’t work for everyone (see above, not a monolith), and that your good intentions may be interpreted negatively. You may offend some people who might then decide to be very vocal about what they didn’t like about your work. Writing can be terrifying, huh? Good thing we all make millions of dollars. Oh wait… 😉
6) When it comes to mental health, anything you wish authors would do more? Less?
 
Here’s a short list 🙂
 
1. Stop portraying therapists as either lecherous dudes who sexually harass main characters or new-age hippie ladies who mean well but are hilariously bumbling at their jobs and completely hopeless at helping their clients. These portrayals are ubiquitous in movies and books and the overall result is to make people less likely to seek therapy. Therapy isn’t right for everyone, but it’s a powerful tool that can help a lot of people and we need to be encouraging people to seek help, not avoid it.
2. Stop portraying psychiatric medication as some sort of evil force that takes away people’s emotions or turns them into zombies. I work at a psychiatric hospital where 90% of the patients are on some sort of antidepressant, antipsychotic, or mood stabilizer and not a single one of them has turned into a zombie. MEDICINE SAVES LIVES. Also, it’s not 1970 anymore. There are tons of different psychiatric medications and if you try one and don’t like how it makes you feel, you can just tell your provider about the side effects and they can often eliminate them by adjusting the dose, dosing schedule, or medication regimen. Sometimes it is literally as simple as taking your dose at night before you go to sleep instead of in the morning. Like therapy, medication isn’t right for everyone, but no doctor is going to force you to take it unless you are in an inpatient facility under a court-mandated hold and an active danger to yourself or others. So if it *might* help, why wouldn’t you want to give it a try? Again, as writers we should think long and hard before we actively discourage people from pursuing treatment that could change their lives (and the lives of those around them) for the better.
3. Be realistic when combining mental illness and romance in the same book. “Love cured my depression” might make for a great Disney movie, but it’s not at all realistic and perpetuating the “love conquers all” myth can do a lot of harm to people who are actively struggling. Long-term unconditional love, like that of a parent or sibling or best friend can definitely help–people with strong support networks are more likely to reach out for assistance–but in books (and YA in particular) there was a tendency in the past to have a struggling character meet a new romantic prospect and find healing through “new love.” I don’t know about you, but to me new relationships are extremely stressful–there’s this element of crushing uncertainty about who likes who more and whether the other person will leave me if they find someone better or if I confide in them or share too much. They tend to exacerbate, not cure someone’s mental illness. I made a point when writing Girl Against the Universe to have Maguire push Jordy away at first because she knows she can’t handle a relationship, and then later in the book there are examples of where their fledgling romance complicates things for both of them as opposed to being some sort of magical salve.
4. Remember that mental illness is a long-term thing for most people. Authors don’t need to “fix” everything by the end of the book. Even if you want a happily ever after for your main character, keep in mind that plenty of people with mental illness are living rewarding and joyful lives. Having your character make the decision to seek help or having them improve somewhat with therapy but acknowledge they’re still going to struggle is a realistic way to portray mental illness in a novel. You don’t need to come up with some kind of miracle cure by the epilogue.