The disproportionally high levels of suicide among (some) minority groups

It’s been written repeatedly, and it’s true: One of the most likely demographic to die by suicide are middle aged, white men. But, as a recent report in USA Today helps illuminate, we shouldn’t confuse this reality with the notion that white men are the most at risk – or that other groups don’t need very real assistance.

USA Today’s story, which was published earlier in the week, came with this stark headline: Suicide Rate for Native American Women is up 139%. Native American and Alaska Natives have a suicide rate 3.5 times higher than the lowest group – an astonishingly high number.

The story highlights a very, very ugly truth: In mental health – just like in health care generally speaking, unfortunately – minority communities have it worse. But, in the case of suicides, not every minority community is this way. For example, suicide rates among African Americans and Pacific Islanders have increased, but remain roughly half the rate of suicides as whites, according to the American Foundation for Suicide Prevention:

suicideRatesByEthnicity.png

Meanwhile, according to the Suicide Prevention Resource Center, rates of suicides among Hispanics also remain far below the United States average, with Hispanics dying by suicide at a rate of slightly more than half of the rest of the United States population.

This is good news, of course, and a very rare bit of good news when it comes to health care for black and Hispanic communities. What drives these rates lower? There are many theories, primarily the idea that strong family and community support provide a degree of resilience not available in other cultures, as well as the idea that self esteem and religiosity rates are higher among African Americans.

All of these factors may tie into why other minority groups have higher rates of suicide. LGBT community members are three times more likely to die by suicide. On average, LGBT members as well as Native Americans, have lower levels of self esteem, community support and family bonds.

In total: The minority suicide rates are not what they would reflexively seem to be. That’s something for all of us to keep in mind as we deal with public policy and suicide.

Does CBD help with depression or anxiety?

In 2018, Donald Trump signed the Farm Bill into law. Among other things, this piece of legislation made legal much of the sale of CBD and hemp, as well as research into this area. – This opens up an array of new potential research, but CBD may have a positive impact on depression and anxiety.

What’s CBD, you ask? First, what it’s not: Marijuana. It is not marijuana. CBD is short for cannabinoid oil, and it became legal to be sold after the 2018 Farm Bill was signed into law.

Specifically, CBD is extracted from hemp plants. It works be manipulating your Endocannibinoid System, a part of your body which regulates a variety of bodily functions, including, potentially, your mood.

Here’s an important point though: While some research has been done, more research is DESPERATELY needed in order to determine CBDs usefulness, effectiveness, proper dosages, long-term impact, etc. At the moment, it is not widely regulated by the FDA, though the FDA has sent out cease and desist letters to some companies which have falsely marketed benefits yet to be proven by research.

Indeed, as of yet, there is no formal regulation when it comes to CBDs marketing or ensuring the quality of ingredients. For example, a 2017 Penn State study surveyed 81 CBD products and found that 70% were mislabeled. As such, if you’re going to purchase CBD, your best bet is to ensure that the label notes it has been independently tested. This means that a product has been evaluated by a 3rd party, and that 3rd party has determined that’s it’s labeling is accurate.

Okay. Enough about the legal disclaimers and warnings. What does the research show?

According to one 2014 study, CBD and Marijuana may show anti-depressant like effects. That finding was replicated in 2018, when a study showed that CBD has “anxiolytic, antipsychotic and neuroprotective properties” and may be useful in fighting a slew of problems, including PTSD and depression.

There’s additional research available, but it does seem clear: There’s opportunity here.

While CBD is not marijuana, and will not get you high like marijuana, some forms of CBD (namely Full Spectrum CBD) do contain trace amounts of marijuana. As such, if you ingest this type of CBD, you may feel some effects. Furthermore, it is possible for Full Spectrum CBD to show up on a drug test – so DON’T TAKE IT if that’s an issue for you.

Furthermore, you should not take any CBD product without consulting with your Doctor or medical professional first. While common side effects of CBD are relatively minor, there can be more problematic impacts for people with Parkinson’s, liver issues, or pregnant/nursing women.

Now that we’ve gotten the warnings out of the way: Is their potential for people with mental illness and CBD? I’d say yes. Anecdotal evidence and some research seems to indicate the potential for relief. Again, more research is needed. Again, don’t do anything without talking to a Doctor or medical professional first. But, yes. More research is now being conducted, this area does prove promising.

 

“Deaths of despair”

I wrote last week about how the particularly sharp rise in suicide and mental illness among our youngest is particularly alarming, arguing it doesn’t bode well for our society if our youngest are becoming so sick so young.

USA Today ran a related story last week about a similar topic, making an argument which has been made repeatedly – that the rise of mental illness, suicides and drug overdoses are all tied to the same basic cause – they are “deaths of despair.” From the article:

“Drug-related deaths among people 18 to 34 soared 108% between 2007 and 2017, while alcohol deaths were up 69% and suicides increased 35%…The analysis of Centers for Disease Control and Prevention data found the increases for these three “deaths of despair” combined were higher than for Baby Boomers and senior citizens.

It’s also worth noting that mental illness, drug and alcohol deaths are higher in certain states than others, and within those states, higher in areas which are struggling economically and offer less hope for the future.

I’ve said it before, and I’ll say it again – the rise of mental illness and suicides goes deeper than brain function and chemistry. We now live in a society where young adults – and younger – are losing hope and increasingly turning to substance abuse to cope. This portends poorly for the future.

What’s the solution? Part of it, of course, has to involve dealing with mental health. As I’ve written about in the past, there is a critical need for more mental health practitioners, fairer insurance practices and targeted programs which seek to destroy mental health stigma. These are answers which I often gravitate towards, as they’re public policy related. They have been studied. There are best practices with answers that, while maybe not “concrete,” can reasonably be expected to make a difference in the problem.

The truth – the full solution – is far more complicated than that.

If we’re using phrases like “deaths of despair” in casual conversation, something is fundamentally broken in our society. We now have entire generations of young adults and kids who are growing up in a world that they simply cannot handle. It goes deeper than mental health, and while all the solutions above that I mentioned are real, they can only address a problem after it has arisen. The preferential way of dealing with deaths of despair is to stop someone from ever reaching that point.

What’s causing these deaths? My random musings, based on available research and the commentary of those far smarter than me: An economy which leaves too many Americans out in the cold, smothering student loan debt, an overwhelming degree of information which leads to a pervasive sense of hopelessness about current affairs and the state of our planet, technology which gives the illusion of connections while pulling us further apart, overwhelming demands on our limited time and resources, a lack of physical activity…I mean, where do you want to start or stop?

The whole concept behind “deaths of despair” are instructive in my mind, because they make it clear that depression is about so much more than mental health. It’s about the state of the family, the economy, the world, and we’re never going to be able to adequately get our arms around this problem without dealing with it holistically.

I wish I could answer in an upbeat way, but this concept is terrifying. We’re poisoning the well, and it’s up to all of us to try to change the universe in which we live to make it a better place, not just for ourselves, or for our family, but for everyone on this planet.

The Canary in the Coal Mine: Mental Illness in College Students

NPR has great article on the mental health “epidemic” in colleges, inspired by The Stressed Years of Their Lives by Dr. Anthony Rostain, which looks at the mental health crisis among college students.

College students, like other demographics, are seeing major increases in mental illnesses. Among the rather depressing (no pun intended) statistics:

  • 44% of college students report symptoms of depression, but 75% of those students do not seek help.
  • Suicide is the 3rd leading cause of death among college students.
  • 80% of students report that they feel stressed on a daily basis.
  • 9% contemplated suicide in the past year.

Why is this jump so acute among college students? In the NPR interview, Dr. Rostain notes that there are a variety of new stresses an impacts on college students today, including a post 9/11 world, the remnants of the great recession, the rise of social media, school shootings, etc. These have all led to an explosion in depression and anxiety, as has the increased pressures which college students face to succeed.

Speaking broadly, I think, unfortunately, that this rise in mental illness among college students is reflective of what is to come. We know that mental illness rates are rising across the board – but we also know that those increases are sharpest among young adults, and sharper still among the youngest of those surveyed.

This has potentially devastating implications as this generation continues to shift into the real world and the workplace. Combine this with the rapidly exploding shortage of mental health practitioners, and the unabated rise of suicides…and we’ve got a big problem. One which will dramatically effect all of our lives.

Fundamentally, I continue to believe that this is a problem which goes well beyond the boundaries of normal public policy. There are things we absolutely must do to expand treatment, access and affordability so that Americans can get the help they need and deserve, no question. But we have to ask ourselves the broader questions: What is causing this rise of depression and anxiety?

These are real issues, and important questions, and ones which must be addressed if we are ever to truly be able to reduce the rates of mental illness and stress which are so prevalent in modern society today. Do I have the answers? Hell no. But I know it’s a question we have to ask.

Bringing this back to where we started: We shouldn’t look at the rising rates of mental illness in college students as something which is occurring in isolation or among a generation which simply hasn’t entered the real world. Given the rise of mental illness across the board, and particularly among young adults, we have to acknowledge that rising mental illness rates in younger demographics has the potential to effect this entire world. What kind of pressures will my children face? Your grandchildren?

Pay attention to this one. It will effect all of us in the future.

 

The biggest reason it’s so hard to find a mental health practitioner

We don’t have enough of them.

As I run around in my real job discussing mental health, I consistently come back to this one central truth: The biggest issue in the area of mental health is that we simply do not have enough people to provide care, or who take Medicare or Medicaid. This means that, when you call a psychologist or psychiatrist, the most likely response is, “I’m sorry, but the Doctor is not accepting patients at this time.”

Consider this: According to a 2016 study, the supply of mental health practitioners by 2025 is expected to be 250,000 short. This disturbing trend is occurring despite the fact that rates of mental illness and suicide continue to increase, and increase alarmingly among the youngest members of our society.

Interestingly, the above article notes that a big part for the rise in demand of mental health practitioners has been a lessening of the stigma which surrounds mental health. As more people become more comfortable with seeking treatment, they put a greater strain on the need for mental health providers.

The problem is particularly bad in rural areas, where, according to this 2018 CNN article, “a majority of non-metropolitan counties (65%) do not have a psychiatrist and almost half of non-metropolitan counties (47%) do not have a psychologist.” This shortage contributes to higher rates of mental illness, addiction, and suicide in rural communities. Indeed, it helps explain why rural areas typically have higher suicide rates than their urban counterparts.

So, what can we do about this?

I’d argue the biggest challenge is the need to increase mental health reimbursement rates, which are historically lower for mental health services. These low rates typically steer prospective doctors away from mental health specialties and into more lucrative practice areas like cardiology and oncology. Increasing these rates would help recruit more practitioners.

Additional funding is also needed for recruitment and loan forgiveness programs. Many states – including Pennsylvania – have begun enacting these programs in an effort to increase access.

Private practitioners and hospital systems also need to step up their game when it comes to this area, but according to the article above, the good news is that they are doing just that. I know that both of the major health networks in my area have said they are looking to expand capacity and recruitment when it comes to psychologists and psychiatrists, and they aren’t the only ones

If you are interested in the interaction between mental health and public policy, you really should pay attention to this space. There will be a lot more in this area in teh next few years.

Mental health resources when you need advice, support or just to feel like you aren’t alone

A not-so-stunning mental health truism for you now: You don’t have all the answers. Neither do I. Neither do any of us. But together, we can maybe discover the truth, or at least lend support.

Depression, and mental illness in general, are fantastic tricksters. They make you think that you are alone, that you are unworthy of support and of love. That isn’t the case, of course. No matter who you are, you are intrinsically worthy of support, kindness and love. But depression makes you think otherwise – makes you think that you are weak and unworthy of all the good things in this world.

On moments where you feel that way, the best thing you can do is talk to someone who loves you or cares about you. Short of that – or in addition to it – there is the internet. I can’t believe I just wrote that sentence, but yes, the internet and some of its kinder corners can actually be incredibly valuable when it comes to finding support for your own issues or illnesses.

For example, have you been to The Mighty? It’s a website with forums and resources for a whole slew of topics – everything from disability to mental illness to other diseases. It’s a great community with good information, and more importantly, other people who are there for you and each other.

I’ve written in the past about Reddit, but that entry was more about how hilarious it can be and just make you smile. Reddit does have a dark side – but it also has a wonderfully supportive segments. Subreddits about depression, depression help or just for people looking for a self confidence boost are filled with supportive people.

If done right, mental health forums can be a great place to trade information, provide support and receive it. To that end, make sure to check out some of the better ones, including at PsychCentral, NAMI and Mental Health America.

Looking for real medical advice? Check out WebMD, The Mayo Clinic or the Substance Abuse and Mental Health Services Administration. These websites have scientifically-based information which can help you get a better idea of your symptoms and where you can find help. And, speaking of finding help, you can always check out Psychology Today’s Therapist Finder.

Also, cute puppy videos. Cause why not.

Look, I’m sure this goes without saying, but the internet is not a cure all for your pain. But it can at least get you moving in the right direction and thinking about better days ahead.

So, yes, go on the internet. See what you can find to help you get through this dark moment. That’s one of the many good things you can find there!

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.

Six Questions: An interview with Laura Silverman, Author of You Asked for Perfect

Today’s interview is with Laura Silverman, who wrote You Asked For Perfect, the story of a super smart, LGBT teenager who is trying to learn to navigate his life in a high pressure world. From the summary:

Senior Ariel Stone is the perfect college applicant: first chair violinist, dedicated volunteer, active synagogue congregant, and expected valedictorian. And he works hard―really hard―to make his success look effortless. A failed calculus quiz is not part of his plan. Not when he’s number one. Not when his peers can smell weakness like a freshman’s body spray.

Ariel throws himself into studying. His friends will understand if he skips a few plans, and he can sleep when he graduates. But as his grade continues to slide, Ariel realizes he needs help and reluctantly enlists a tutor, his classmate Amir. The two have never gotten along, but Ariel has no other options.

Ariel discovers he may not like calculus, but he does like Amir. Except adding a new relationship to his long list of commitments may just push him past his limit.

1) Do you think that experiencing mental illness is a requirement for any author who deals with this topic?
I don’t think it’s a requirement, but I do think if a writer is ever writing outside of their own personal experience, it should be done with a great amount of both research and empathy.
2) Your book obviously deals with a gay teenager, a group which faces enormous mental health pressures. Can you talk a little about writing a character with mental health challenges from that perspective?
Ariel is a bisexual teen, but his anxiety in the book is related to academic pressure not his sexuality. I wanted to write a book about the extreme academic pressure teens deal with today, as I believe it’s something so many teens experience but is rarely written about.
3) As I type this questions, your book is number one in “Teen & Young Adult Jewish Fiction.” What has your experience been like in terms of the interaction between religion and mental health?
I grew up in a very supportive Jewish community and wanted to reflect that in this novel. Ariel’s Jewish community is a place of comfort and warmth for him. Although services certainly take up more time in his busy schedule, adding additional stress, overall his Jewish community is an incredibly supportive aspect of his life. And his rabbi is actually one of the people who helps him the most throughout the book.
4) Your book addresses many of the societal pressures which teenagers face today. What do you think any of us can do to try to tamp down those pressures?
I think we need to send the message that grades do not define you. There’s so much pressure to excel in school and get into top universities, but while education is important, it should be about the learning experience not about top SAT scores and AP credits.
5) Many of the reviews of You Asked For Perfect note that you seem to perfectly capture what it’s like to be a teenager in a high pressure environment. How did you do that??
I went to one of those high schools! Although my experience wasn’t as intense as my protagonist Ariel, I experienced the exhaustion of taking multiple AP classes, taking extra electives, the pressure to excel, the fear of scoring a low grade. I also did a lot of research for the book. I talked to high achieving students about their experiences and watched documentaries and read books.
6) If you could do it again – anything you’d do differently?
With the book? I wouldn’t change a thing!

Feeling sad? Maybe get a puppy or a kitten

Alright, alright, I know that my entry earlier in the week was a bit of a bummer. Well, let me qualify that: It could be a bummer on the surface, since it was about my recently deceased dog. But if you look beyond just the words I wrote, you’ll see that the overarching theme of the entry was more than just sadness. I’m obviously heartbroken that Molly is gone, but the point of my entry wasn’t just how sad it was: It was how much joy the dog gave us for ten wonderful years.

Obviously, I’m not the only one who felt that way about their pet, and there’s real science there.

The Anxiety & Depression Association of America calls it “The Pet Effect”:

 It’s also no surprise that 98% of pet owners consider their pet to be a member of the family. Not only are people happier in the presence of animals, they’re also healthier. In a survey of pet owners, 74% of pet owners reported mental health improvements from pet ownership, and 75% of pet owners reported a friend’s or family member’s mental health has improved from pet ownership.

And let’s be clear here – the benefits of pet ownership go beyond one survey and beyond the notion of just feeling good. According to a meta-analysis of 17 studies, pet ownership was associated with major mental health improvements. According to the meta-analysis itself, 15 of the 17 studies reported positive mental health benefits of pet ownership (though 9 actually also reported negative benefits as well).

The study then broke the benefits of pet ownership into broader themes. These included:

  • Providing comfort, emotional support and companionship, as well as mitigating worry and stress. This was particularly true for veterans suffering from PTSD. Pets also provide a role as companions and comforters and were perceived by humans to be replacement family members, and friends capable of listening without judgement.
  • Encouraging physical activity and distracting someone from their negative symptoms. One study went as far as finding that people with pets were more likely to get out of their house for mental health care than those who didn’t have pets. Furthermore, the distraction of a pet was found to help alleviate ruminative symptoms by encouraging humans to stay more in the present.
  • Encouragement of social interaction. Pets encouraged humans to interact more with others and better integrate their humans to the community.
  • Pets provide their humans with a sense of self worth and identity. For many, a pet is another reason to live – its something that you love and care for, and becomes a positive part of who you are.

Pets can create negative symptoms too, of course. They are financial costs (potentially significant ones – also, again, GET PET INSURANCE) and may create a burden in terms of housing.

So, if you’re down, should you get a pet? Well, yeah, maybe. It’s not a cure all. Nothing is a cure all. But if you are ready for the responsibility (and it is a major responsibility, trust me), having a two or four legged companion may ease your suffering and give you joy and love.

Six ways that humanity once treated mental illness (which would probably kill you today) – Part 2

Hello! On Monday, I published Part 1 of a historical look at the ways in which mental illness was once treated. Here’s Part 2. It’s not any better.

4. Fever therapy

Some general basics here: You don’t just get a fever because your body hates you. Fevers occur when your body has an infection, and your temperature raises to fight off the foreign germ invaders.

Keep this in mind, and allow me to introduce you to Hilda, a patient who was suffering from what the early 20th century referred to as “general paresis of the insane,” (or GPI) caused by advanced syphilis. Hilda was confined to a psychiatric clinic in Austria when she came down with a pretty serious fever. She recovered from the fever…and her psychosis.

How they thought it worked

Hilda’s doctor, Dr. Julius Wagner-Jauregg, attributed Hilda’s sudden recovery to the fever. Using other GPI patients, Wagner-Jauregg began to experiment by injecting patients with a slew of other illnesses, including streptococcal bacteria (strep throat), tuberculin (tuberculosis) and malaria (freakin malaria).

However, for many, the therapy actually worked:

“Patients who previously behaved bizarrely and talked incoherently now were composed and conversed normally with Dr. Wagner-Jauregg. Some patients even appeared cured of their syphilis entirely. Here in the twenty-first century it may not seem like a favorable bargain to trade one awful disease for another, but at least malaria was treatable with quinine, a cheap and abundant extract of tree bark.”

Fever therapy (also known as Pyrotherapy) was used as late as the 1930s, when special machines were constructed to induce a fever.

But, actually….

The therapy did work…for GPI. And GPI only. And it did have the nasty side effect of giving someone whatever deadly illness they were injected with, complete with a 15% chance of…death.

The problem, of course, is that this wasn’t understood. Pyrotherapy (side note: this is the greatest name ever, because it sounds like you are being healed with fire) worked by killing the microorganisms which caused GPI, but there was no such equivalent for other forms of mental illness.

Meanwhile, pyrotherapy was used to treat a variety of different psychiatric disorders, including depression and schizophrenia. New, exciting ways were brought in to treat fevers to, expanding to everything from typhoid to electric blankets. Observations at the time showed that the therapy could work in very limited circumstances, but most of the time, there was no improvement.

As for Wagner-Jueregg? He, too, won a Noble prize. Apparently, they are not as hard to get as one would previously expect!

5. Hydrotherapy

Nothing’s calmer than a nice, relaxing bath to destress you after a long, tough day, right? Well, what about being soaked in icy cold towels and made to stay in a bath overnight?

Wait, what?

How they thought it worked

According to this 2015 Psychology Today article, in older times, mental illness was thought about in “spiritual terms” – and water was seen as an antidote. As a result, water became to be viewed as a common cure to a variety of mental illnesses. This became particularly prominent in the 18th century, when two types of hydrotherapies became prominent:

• The douche (shower), in which a “constant torrent of water could either cool the heat of madness or rouse the melancholic.”
• The balenum (bath), which was just meant to calm someone down.

With the rise of psychiatric hospitals, the practice became more prominent and a variety of different pieces of equipment were developed for the practice, including bath boxes, dunking devices (I don’t think they mean those carnival games) and more.

While this all sounds relatively harmless, in it’s more extreme forms, the therapy could be downright cruel and dangerous. According to one review, in some cases, “A patient could expect a continuous bath treatment to last from several hours to several days, or sometimes even over night.”

But, actually….

The therapy faded from prominence in the early 20th century as other bad ideas replaced this one (insulin shock, electroshock and more).

Here’s the thing though: While forcing someone to do anything against their will is almost always a bad thing, taking a bath can be good for your mental health, so this therapy wasn’t entirely off base! According to this Guardian article, taking a bath can increase your core temperature. This, in turn, is associated with a “moderate but persistent” mood increase.

So, hop on into the tub! Just…don’t strap yourself in. Bad call there.

6. Trephination

Trephination is the fun-filled process by which a hole was cut in someone’s skull. It is one of the oldest forms of therapy, with evidence for the practice dating all the way back to 6500 BCE. Its use wasn’t just confined to mental illness; no no, that would at least limit those who suffered from this God-awful practice. Instead, trepanning was used for a variety of illnesses, including seizures, migraines and head wounds, as well as pain.

Is was used as recently as the Renaissance, around which time one can assume that it began to occur to practitioners that cutting a big ole hole in someone’s skull was not necessarily the greatest practice.

How they thought it worked

Similar to hydrotherapy above, trephination was used because of a different understanding of mental illness. The hole cut in one’s skull would allow for bad spirits to get out, or good spirits to get in. This, in turn, would relieve mental illness.

At the same time, trephination had other uses. Skull discs would be collected and used as good luck charms or amulets, and in ancient Egypt, the scrapings of a skull were used to make potions (hey, why let a good thing go to waste!)

What is even more remarkable is that these operations did not kill everyone on the spot. There is ample evidence that many survived the procedure, as evidenced by skull regrowth among those who had the operation.

But, actually….

Do I really need a “but, actually” section here? Drilling holes in the skulls of people is, generally speaking, a bad practice, m’kay?

Now, that being said, there are exceptions to every rule, and skull-holes has those exceptions as well. In limited instances, such as in the case of brain injury, and specifically epidural and subdural hematomas.
Of course, skull removal is never used for mental illness at this point. Thank God.